What antibiotic is recommended for use in oral surgery?

From the Guidelines

For oral surgery, amoxicillin is typically the first-line antibiotic of choice, usually prescribed at 2 g orally 1 hour before the procedure, as recommended by the American Heart Association 1.

Key Considerations

• Prophylactic antibiotics are generally only recommended for patients at high risk of infection or those with specific medical conditions like prosthetic heart valves, history of infective endocarditis, certain congenital heart defects, or immunocompromised states.
• Most healthy patients undergoing routine oral surgery do not require prophylactic antibiotics, as emphasized by the 2015 AHA Endorsed by IDSA guidelines 1.
• When treating active infections, antibiotics should be combined with appropriate surgical intervention such as drainage or extraction.

Alternative Antibiotics

• For patients with penicillin allergies, clindamycin (600 mg orally 1 hour before the procedure) or azithromycin (500 mg on day one, followed by 250 mg daily for 4 days) are appropriate alternatives, as suggested by the 2017 AHA/ACC guidelines 1.
• The choice of antibiotics and dose adjustments should be made based on comments from the patient’s nephrologist before the implant surgery in order to decrease the side effects from CKD, as recommended by the 2017 International journal of oral science study 1.

Important Notes

• Always complete the full course of antibiotics as prescribed, even if symptoms improve, to prevent antibiotic resistance.
• Aminoglycoside antibiotics and tetracyclines should be avoided in CKD patients due to their nephrotoxicity, as warned by the 2017 International journal of oral science study 1.
• The most recent guidelines from the American Heart Association and other reputable organizations should be consulted for the most up-to-date recommendations on antibiotic prophylaxis for oral surgery, as highlighted by the 2020 Clinical Infectious Diseases review 1.

From the FDA Drug Label

Amoxicillin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)] Gram-Positive Bacteria Enterococcus faecalis Staphylococcus spp. Streptococcus pneumoniae Streptococcus spp (alpha and beta-hemolytic) Gram-Negative Bacteria Escherichia coli Haemophilus influenzae Helicobacter pylori Proteus mirabilis

The antibiotic to use for oral surgery is amoxicillin 2.

• Key points:
  • Amoxicillin is active against a broad spectrum of bacteria, including both Gram-positive and Gram-negative microorganisms.
  • It is effective against common oral pathogens, making it a suitable choice for oral surgery.
  • The dosage and administration of amoxicillin should be determined based on the specific needs of the patient and the type of oral surgery being performed.

From the Research

Antibiotic Use in Oral Surgery

• The use of antibiotics in oral surgery is a topic of ongoing debate, with some studies suggesting their effectiveness in preventing postoperative infections 3, 4.
• A study published in 2012 found that amoxicillin prophylaxis was effective in preventing postoperative infection in complex oral surgery, especially when mandibular third molars and multiple avulsions were involved 3.
• Another study published in 2020 found that a single preoperative dose of prophylactic amoxicillin was sufficient for patients undergoing routine dental implant placement procedures, and that additional postoperative doses did not provide significant benefits 5.

Recommended Antibiotics

• Amoxicillin is a commonly recommended antibiotic for use in oral surgery, particularly for procedures such as surgical extractions of third molars and complex implants 3, 6.
• The use of other antibiotics, such as ciprofloxacin and metronidazole, may also be effective in preventing surgical-site infections, as seen in a study on colon surgery 7.

Indications for Antibiotic Use

• Antibiotic prophylaxis is recommended for certain oral and maxillofacial procedures, including:
  • Surgical extractions of third molars
  • Comminuted mandibular fractures
  • Temporomandibular joint replacements
  • Clean-contaminated tumour removal
  • Complex implants 6
• However, antibiotic use is not routinely recommended for fractures of the upper or midface facial thirds 6.