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Prophylactic Antibiotics in Facial Fractures: Evaluating Current Practice Patterns
Sebastian Brooke1, Neerav Goyal, MD1, Brett Michelotti, MD1, Dan Henrichsen, DMD2, Fred Fedok, MD1, Donald Mackay, MD1, Thomas Samson, MD1.
1Penn StateHershey Medical Center, Hummelstown, PA, USA, 2Conestago Oral and Maxillofacial Surgery LTD, Lancaster, PA, USA.
BACKGROUND: Plastic surgeons, oral and maxillofacial surgeons, and otolaryngologists manage facial fractures. Several studies have evaluated the use of antibiotics in facial trauma with evidence demonstrating that twenty four hours of peri-operative prophylaxis may reduce infections. To our knowledge no studies have evaluated the prophylactic antibiotic practice patterns of providers caring for these injuries. The goal of this study was to evaluate the current use of antibiotics in operative and non-operative facial fractures across multiple disciplines.
METHODS:A fourteen question anonymous online-based survey, created through REDCap (Research Electronic Data Capture; The Penn State Clinical & Translational Research Institute, Pennsylvania State University CTSA, NIH/NCATS Grant Number UL1 TR000127) was distributed via email to members of the American Society of Maxillofacial Surgeons and the Association of Head and Neck Surgeons in order to query plastic surgeons, otolaryngologists, and oral surgeons with particular interest in facial fractures. Surgeon demographic data and current antibiotic prescribing practices in both operative and non-operative facial fractures was obtained.
RESULTS: 165 total respondents included 60 plastic surgeons, 7 oral and maxillofacial surgeons, 96 otolaryngologists, and 2 respondents who reported dual certification in plastic surgery and otolaryngology. 51.6% of respondents were in their first 10 years of practice with the remainder ranging from 11 to greater than 30 years of experience. Geographic distribution included the Northeast (32.2%), the South (26.1%), Midwest (21.2%), the West (13.3%), and the Pacific (7.3%). For operative fractures, 98.2% of respondents either always (75%) or sometimes (23.2%) provide antibiotic prophylaxis. Of those operative fractures for which antibiotic prophylaxis was given, the most frequent fracture types were dentate (90.8%) and non-dentate (73.5%) mandible fractures followed by frontal sinus fractures (57.4%). In non-operative facial fractures, 63.6% report either always (3.6%) or sometimes (60%) providing prophylaxis. Similar to operative fractures, prophylaxis for non-operative fractures was also most frequently reported for dentate (84.5%) and non-dentate (72.5%) mandible fractures followed by frontal sinus fractures (65%). Duration of peri-operative antibiotics ranged from a single pre-operative dose (17% respondents), twenty four hours (12.6% respondents), three to seven days (60.4% respondents), to ten to fourteen days (10.1% respondents). For patients without penicillin allergies, the most frequently prescribed antibiotics were first generation cephalosporins (52.4%), augmentin/unasyn (16.4%), and Clindamycin (13.3%). For those with penicillin allergies, Clindamycin was most frequently administered (79.4%).
CONCLUSIONS: To our knowledge, this is the first survey of plastic surgeons, otolaryngologists and oral surgeons to evaluate the use of prophylactic antibiotics in facial fractures. Prophylactic antibiotic practice patterns for operative and non-operative fractures, duration of prophylaxis, and type of antibiotics used remains varied. Mandible fractures, followed by frontal sinus fractures, most frequently receive prophylaxis for both operative and non-operative fractures. Three to seven days is the most frequent duration that antibiotics are prescribed. Despite limited oral gram negative and anaerobic coverage, first generation cephalosporins remain the most common antibiotic prescribed for prophylaxis, while clindamycin is the antibiotic of choice in penicillin allergic patients.
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