Antibiotic prophylaxis for preventing infectious complications in orthognathic surgery

Romina Brignardello‐Petersen; Alonso Carrasco‐Labra; Ignacio Araya; Nicolás Yanine; Luis Cordova Jara; Julio Villanueva

doi:10.1002/14651858.CD010266.pub2

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Figure 1

Flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Short‐term versus long‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 2.1

Comparison 2 Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 3.1

Comparison 3 Preoperative versus short‐term antibiotic prophylaxis, Outcome 1 Surgical site infection.

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Analysis 3.2

Comparison 3 Preoperative versus short‐term antibiotic prophylaxis, Outcome 2 Adverse events.

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Analysis 4.1

Comparison 4 Amoxicillin versus ampicillin, Outcome 1 Surgical site infection.

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Analysis 4.2

Comparison 4 Amoxicillin versus ampicillin, Outcome 2 Adverse events.

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Analysis 5.1

Comparison 5 Amoxicillin and clavulanic acid versus cefuroxime, Outcome 1 Surgical site infection.

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Short‐term antibiotic prophylaxis compared with long‐term antibiotic prophylaxis in patients undergoing orthognathic surgery
Patient or population: patients undergoing orthognathic surgery Intervention: short‐term antibiotic prophylaxis Comparison: long‐term antibiotic prophylaxis
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Short‐term	Long‐term
Surgical site infection Follow‐up: 2 to 36 weeks	168 per 1000^a	71 per 1000 (41 to 125)	RR 0.42 (0.24 to 0.74)	472 (7 studies)	⊕⊕⊕⊝ moderate^b	This outcome was measured using different definitions. We accepted all authors' definitions
Systemic infection	Not reported				‐	This outcome was not reported in any of the trials
Adverse events	Not reported				‐	This outcome was not reported in any of the trials
Duration of hospital stay	Not reported				‐	This outcome was not reported in any of the trials
Health‐related quality of life	Not reported				‐	This outcome was not reported in any of the trials
The basis for the assumed risk* (e.g. mean control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aAssumed risk based on control arms of included trials. ^bMost of these trials were judged to have unclear risk of bias in the domains of allocation concealment and blinding.

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Preoperative antibiotic prophylaxis compared with short‐term antibiotic prophylaxis in patients undergoing orthognathic surgery
Patient or population: patients undergoing orthognathic surgery Intervention: preoperative antibiotic prophylaxis Comparison: short‐term antibiotic prophylaxis
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Preoperative	Short‐term
Surgical site infection Follow‐up: 4 to 12 weeks	82 per 1000^a	28 per 1000 (8 to 101)	RR 0.34 (0.09 to 1.22)	220 (2 studies)	⊕⊕⊝⊝ low^b,c	This outcome was measured using different definitions. We accepted all authors' definitions
Adverse events Follow‐up: up to 12 weeks	0 per 35 See comment	0 per 35 See comment	Not estimable	70 (1 study)	⊕⊕⊝⊝ low^d,e	No adverse events were reported in any of arms of the trial
Systemic infection	Not reported				‐	This outcome was not reported in any of the trials
Duration of hospital stay	Not reported				‐	This outcome was not reported in any of the trials
Health‐related quality of life	Not reported				‐	This outcome was not reported in any of the trials
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aAssumed risk based on control arms of included trials. ^bMost of the trials were judged to have unclear risk of bias in the domains of allocation concealment and blinding. ^cThe 95% CI of the pooled estimate suggests both benefit and harm. ^dThe trial was judged to have unclear risk of bias in the domains of allocation concealment and blinding. ^eThe number of participants included in this analysis is below the optimal information size.

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Comparison 1. Short‐term versus long‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	7	472	Risk Ratio (IV, Random, 95% CI)	0.42 [0.24, 0.74]

Comparison 1. Short‐term versus long‐term antibiotic prophylaxis

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Comparison 2. Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	6	438	Risk Ratio (IV, Random, 95% CI)	0.41 [0.22, 0.75]

Comparison 2. Sensitivity analysis: short‐term versus long‐term antibiotic prophylaxis

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Comparison 3. Preoperative versus short‐term antibiotic prophylaxis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	2	220	Risk Ratio (IV, Fixed, 95% CI)	0.34 [0.09, 1.22]

2 Adverse events Show forest plot	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Preoperative versus short‐term antibiotic prophylaxis

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Comparison 4. Amoxicillin versus ampicillin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	1		Risk Difference (IV, Random, 95% CI)	Totals not selected

2 Adverse events Show forest plot	1	42	Risk Ratio (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 4. Amoxicillin versus ampicillin

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Comparison 5. Amoxicillin and clavulanic acid versus cefuroxime

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Surgical site infection Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Totals not selected

Comparison 5. Amoxicillin and clavulanic acid versus cefuroxime

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