J Korean Assoc Oral Maxillofac Surg.  2018 Jun;44(3):103-106. 10.5125/jkaoms.2018.44.3.103.

Comparison of the efficacy of amoxicillin-clavulanic acid with metronidazole to azithromycin with metronidazole after surgical removal of impacted lower third molar to prevent infection

• Sayd S
• Vyloppilli S
• Kumar K
• Subash P
• Kumar N
• Raseel S

• KMID: 2414428
• DOI: http://doi.org/10.5125/jkaoms.2018.44.3.103

Abstract

OBJECTIVES
The goal of the study was to investigate the clinical effects of amoxicillin-clavulanic acid (500+125 mg) with metronidazole 400 mg administered three times daily (Group I) versus azithromycin 500 mg administered once daily and with metronidazole 400 mg three times daily (Group II) for the prevention of postoperative infection following mandibular third molar surgical removal.
MATERIALS AND METHODS
The study design was a single-center prospective study. Patients who reported to the Department of Oral and Maxillofacial Surgery between February 2015 and January 2017 for removal of mandibular third molar were screened, and 108 patients were chosen. One surgeon carried out all procedures. Patients were prescribed antibiotics until the two groups contained a similar number of cases.
RESULTS
Our data showed that Group II had fewer incidences of surgical site infection, but with no statistical significance.
CONCLUSION
Although both treatments are used routinely after removal of the mandibular third molar, neither is significantly better than the other.

Keyword

Impacted third molar removal; Antibiotic prophylaxis; Amoxicillin; Azithromycin; Metronidazole

MeSH Terms

Amoxicillin
Amoxicillin-Potassium Clavulanate Combination*
Anti-Bacterial Agents
Antibiotic Prophylaxis
Azithromycin*
Humans
Incidence
Metronidazole*
Molar, Third*
Prospective Studies
Surgery, Oral
Surgical Wound Infection
Amoxicillin
Amoxicillin-Potassium Clavulanate Combination
Anti-Bacterial Agents
Azithromycin
Metronidazole

Figure

• 

  Fig. 1 Description of patients with surgical site infection under an antibiotic regimen.

Reference

1. Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res. 2012; 174:33–38.

2. Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice: review. Asian Pac J Trop Biomed. 2012; 2:749–754.

3. Lacasa JM, Jiménez JA, Ferrás V, Bossom M, Sóla-Morales O, García-Rey C, et al. Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg). Int J Oral Maxillofac Surg. 2007; 36:321–327.

4. Graziani F, Corsi L, Fornai M, Antonioli L, Tonelli M, Cei S, et al. Clinical evaluation of piroxicam-FDDF and azithromycin in the prevention of complications associated with impacted lower third molar extraction. Pharmacol Res. 2005; 52:485–490.

5. Arteagoitia I, Diez A, Barbier L, Santamaría G, Santamaría J. Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflammatory complications following impacted mandibular third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:e11–e18.

6. Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg. 2007; 65:1909–1921.

7. Richardson DT, Dodson TB. Risk of periodontal defects after third molar surgery: an exercise in evidence-based clinical decision-making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:133–137.

8. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116:1736–1754.

9. Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg. 2007; 65:177–185.

10. Poeschl PW, Eckel D, Poeschl E. Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity? J Oral Maxillofac Surg. 2004; 62:3–8. discussion 9.

11. Chuang SK, Perrott DH, Susarla SM, Dodson TB. Risk factors for inflammatory complications following third molar surgery in adults. J Oral Maxillofac Surg. 2008; 66:2213–2218.

12. Yoshii T, Hamamoto Y, Muraoka S, Kohjitani A, Teranobu O, Furudoi S, et al. Incidence of deep fascial space infection after surgical removal of the mandibular third molars. J Infect Chemother. 2001; 7:55–57.

13. Susarla SM, Sharaf B, Dodson TB. Do antibiotics reduce the frequency of surgical site infections after impacted mandibular third molar surgery? Oral Maxillofac Surg Clin North Am. 2011; 23:541–546. vi

14. Addy LD, Martin MV. Azithromycin and dentistry: a useful agent? Br Dent J. 2004; 197:141–143. discussion 138.

15. Blakey GH, Marciani RD, Haug RH, Phillips C, Offenbacher S, Pabla T, et al. Periodontal pathology associated with asymptomatic third molars. J Oral Maxillofac Surg. 2002; 60:1227–1233.

16. Ishihama K, Kimura T, Yasui Y, Komaki M, Ota Y. Azithromycin as prophylaxis for the prevention of postoperative infection in impacted mandibular third-molar surgery. J Infect Chemother. 2006; 12:31–35.

17. Delilbasi C, Saracoglu U, Keskin A. Effects of 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid on the prevention of alveolar osteitis following mandibular third molar extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94:301–304.

18. Yoshii T, Hamamoto Y, Muraoka S, Furudoi S, Komori T. Differences in postoperative morbidity rates, including infection and dry socket, and differences in the healing process after mandibular third molar surgery in patients receiving 1-day or 3-day prophylaxis with lenampicillin. J Infect Chemother. 2002; 8:87–93.

19. Bulut E, Bulut S, Etikan I, Koseoglu O. The value of routine antibiotic prophylaxis in mandibular third molar surgery: acute-phase protein levels as indicators of infection. J Oral Sci. 2001; 43:117–122.

20. Piecuch JF, Arzadon J, Lieblich SE. Prophylactic antibiotics for third molar surgery: a supportive opinion. J Oral Maxillofac Surg. 1995; 53:53–60.

21. Peterson LJ. Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1990; 48:617–620.

22. Monaco G, Staffolani C, Gatto MR, Checchi L. Antibiotic therapy in impacted third molar surgery. Eur J Oral Sci. 1999; 107:437–441.

23. Thomas DW, Hill CM. An audit of antibiotic prescribing in third molar surgery. Br J Oral Maxillofac Surg. 1997; 35:126–128.