From the Guidelines
Antibiotic prophylaxis is not routinely recommended for closed orbital floor fractures, but may be considered for open fractures or those with communication with the sinuses. When antibiotic prophylaxis is indicated, the choice of antibiotic should be based on the likely pathogens involved, which include staphylococci, streptococci, H. influenzae, and enterobacteria 1. Some possible regimens for antibiotic prophylaxis in orbital floor fractures include:
- Cefazolin 2g slow IV for closed fractures requiring intrafocal osteosynthesis, with reinjection of 1g if duration > 4 h, limited to the operative period (24 hours max) 1
- Cefamandole 1.5g slow IV for soft tissue wounds non-contused, with or without lesion of artery, nerve, tendon, with reinjection of 0.75g if duration > 2 h, limited to the operative period (24 hours max) 1
- Cefuroxime 1.5g slow IV for articular wounds, with reinjection of 0.75g if duration > 2 h, limited to the operative period (24 hours max) 1
- Clindamycin 900 mg slow IV + gentamicin 5 mg/kg/d for patients with allergies, limited to 48 hours maximum 1 It's essential to note that the use of antibiotic prophylaxis should be individualized based on the patient's specific condition, including the presence of any underlying medical conditions, such as diabetes, or the presence of intraocular implants 1. Additionally, patients should be advised to avoid nose blowing, which can force bacteria from the sinuses into the orbit, and close follow-up is necessary to monitor for signs of infection, which would require prompt medical attention and possibly intravenous antibiotics.
From the Research
Antibiotics for Orbital Floor Fractures
- The use of antibiotics for orbital floor fractures is a topic of debate, with some studies suggesting that they may not be necessary for nonoperative cases 2, 3.
- A study published in 2017 found that cephalexin and amoxicillin-clavulanate were the most commonly prescribed oral antibiotics for orbital fractures, and that they were equally effective 4.
- Another study published in 2021 found that patients with nonoperative orbital fractures who did not receive antibiotics had no infectious complications, suggesting that antibiotics may not be necessary in these cases 2.
- A randomized controlled trial published in 2013 found that a 1-day course of antibiotics was as effective as a 5-day course in preventing infective complications after displaced orbital fractures 5.
- A prospective study published in 2021 found that none of the 268 patients with closed, nonoperative orbital and/or zygomatic fractures who did not receive antibiotics developed infectious complications, further supporting the idea that antibiotics may not be necessary in these cases 3.
Specific Antibiotics
- Cephalexin and amoxicillin-clavulanate are commonly prescribed oral antibiotics for orbital fractures 4.
- Amoxicillin/clavulanic acid has been used in studies as a prophylactic antibiotic for orbital fractures 5.
Duration of Antibiotic Treatment
- A study published in 2013 found that a 1-day course of antibiotics was as effective as a 5-day course in preventing infective complications after displaced orbital fractures 5.
- Another study published in 2017 found that 5-to-7 day courses of antibiotics had no increased infections compared to 10-to-14 day courses 4.