title: Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures.
abstract: Facial fractures are commonly managed nonoperatively. Patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. The aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. A total number of 289 patients who were admitted to our level I trauma center with nonoperative facial fractures from the beginning of 2012 to the end of 2014 were studied. Patients were categorized into 3 groups: no antibiotic prophylaxis, short-term antibiotic prophylaxis (1-5 days), and long-term antibiotic prophylaxis (>5 days). The primary outcome was the incidence of facial soft tissue infection and Clostridium difficile colitis. Fifty patients received no antibiotic prophylaxis. Sixty-three patients completed a short course of antibiotic prophylaxis and 176 patients received long-term antibiotics. Ampicillin/sulbactam, amoxicillin/clavulanic acid, or a combination of both were used in 216 patients. Twenty-three patients received clindamycin due to penicillin allergy. Short and long courses of antibiotic prophylaxis were administered more commonly in patients with concomitant maxillary and orbital fractures (P <0.0001). No mortality was found in any group. Soft tissue infection was not identified in any patient. C. difficile colitis was identified in 1 patient who had received a long course of antibiotic prophylaxis (P = 0.7246). There was no difference in the outcome of patients receiving short-term, long-term, and no antibiotic prophylaxis. Prospective randomized studies are needed to provide further clinical recommendations.
authors.affiliation: Section of Trauma and Acute Care Surgery, Department of Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Malekpour
authors.forename: Kelly
authors.initials: K
authors.lastname: Bridgham
authors.forename: Nina
authors.initials: N
authors.lastname: Neuhaus
authors.forename: Kenneth
authors.initials: K
authors.lastname: Widom
authors.forename: Megan
authors.initials: M
authors.lastname: Rapp
authors.forename: Diane
authors.initials: D
authors.lastname: Leonard
authors.forename: Susan
authors.initials: S
authors.lastname: Baro
authors.forename: James
authors.initials: J
authors.lastname: Dove
authors.forename: Marie
authors.initials: M
authors.lastname: Hunsinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Blansfield
authors.forename: Mohsen
authors.initials: M
authors.lastname: Shabahang
authors.forename: Denise
authors.initials: D
authors.lastname: Torres
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wild
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005151:Facial Injuries / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012887:Skull Fractures / Q000150:complications*; D018461:Soft Tissue Infections / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents