title: Antibiotic Prophylaxis in Orbital Fractures.
abstract: OBJECTIVE
  To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics.
  
  
  METHODS
  Development of orbital infection.
  
  
  RESULTS
  One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198.
  
  
  CONCLUSIONS
  Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.
authors.affiliation: Department of Ophthalmology, The George Washington University, Washington D.C., USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Reiss
authors.affiliation: Department of Ophthalmology, The George Washington University, Washington D.C., USA.
authors.forename: Lamise
authors.initials: L
authors.lastname: Rajjoub
authors.affiliation: Department of Ophthalmology, The George Washington University, Washington D.C., USA.
authors.forename: Tamer
authors.initials: T
authors.lastname: Mansour
authors.affiliation: Department of Ophthalmology, The George Washington University, Washington D.C., USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, The George Washington University, Washington D.C., USA.
authors.forename: Aisha
authors.initials: A
authors.lastname: Mumtaz
keywords: Amoxicillin-clavulanate; Antibiotic prophylaxis; Cephalexin; Orbital fracture; Post-traumatic orbital cellulitis