6533b85ffe1ef96bd12c1c05

RESEARCH PRODUCT

Efficacy of amoxicillin and amoxicillin/clavulanic acid in the prevention of infection and dry socket after third molar extraction: a systematic review and meta-analysis

Joseba SantamariaEva RamosMaría Iciar ArteagoitiaLuis BarbierGorka Santamaría

subject

medicine.medical_specialtyDry SocketOdontologíaReviewTooth ExfoliationPlaceboAmoxicillin-Potassium Clavulanate Combinationlaw.invention03 medical and health sciences0302 clinical medicineRandomized controlled trialDouble-Blind MethodlawClavulanic acidInternal medicinemedicineHumansGeneral DentistryInfection Control030219 obstetrics & reproductive medicineAmoxicillin/clavulanic acidbusiness.industryAmoxicillin030206 dentistryAmoxicillinmedicine.disease:CIENCIAS MÉDICAS [UNESCO]Ciencias de la saludSurgeryAnti-Bacterial AgentsDry socketOtorhinolaryngologyUNESCO::CIENCIAS MÉDICASNumber needed to treatSurgeryMolar ThirdAmoxicillin-Potassium Clavulanate CombinationOral Surgerybusinessmedicine.drug

description

Background: Prophylactic use of amoxicillin and amoxicillin/clavulanic acid, although controversial, is common in routine clinical practice in third molar surgery. Material and Methods: Our objective was to assess the efficacy of prophylactic amoxicillin with or without clavulanic acid in reducing the incidence of dry socket and/or infection after third molar extraction. We conducted a systematic review and meta-analysis consulting electronic databases and references in retrieved articles. We included double-blind placebo-controlled randomized clinical trials published up to June 2015 investigating the efficacy of amoxicillin with or without clavulanic acid on the incidence of the aforementioned conditions after third molar extraction. Relative risks (RRs) were estimated with a generic inverse-variance approach and a random effect model using Stata/IC 13 and Review Manager Version 5.2. Stratified analysis was performed by antibiotic type. Results: We included 10 papers in the qualitative review and in the quantitative synthesis (1997 extractions: 1072 in experimental groups and 925 in controls, with 27 and 74 events of dry socket and/or infection, respectively). The overall RR was 0.350 (p<0.001; 95% CI 0.214 to 0.574). We found no evidence of heterogeneity (I2 =0%, p=0.470). The number needed to treat was 18 (95% CI 13 to 29). Five studies reported adverse reactions (RR=1.188, 95% CI 0.658 to 2.146, p =0.567). The RRs were 0.563 for amoxicillin (95% CI 0.295 to 1.08, p=0.082) and 0.215 for amoxicillin/clavulanic acid (95% CI 0.117 to 0.395, p<0.001). Conclusions: Prophylactic use of amoxicillin does not significantly reduce the risk of infection and/or dry socket after third molar extraction. With amoxicillin/clavulanic acid, the risk decreases significantly. Nevertheless, considering the number needed to treat, low prevalence of infection, potential adverse reactions to antibiotics and lack of serious complications in placebo groups, the routine prescription of amoxicillin with or without clavulanic acid is not justified

yearjournalcountryeditionlanguage
2016-03-01
http://hdl.handle.net/10550/54800