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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.

Arteagoitia MI, Barbier L, Santamaría J, Santamaría G, Ramos E - Med Oral Patol Oral Cir Bucal (2016)

Bottom Line: We found no evidence of heterogeneity (I2=0%, p=0.470).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.

View Article: PubMed Central - PubMed

Affiliation: Servicio Cirugía Maxilofacial, Hospital Universitario de Cruces, Plaza de Cruces s/n, Barakaldo (Bizkaia), Spain, jsz@clinicaimd.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

L'Abbé plot, Funnel plot, Cumulative plot.
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Figure 3: L'Abbé plot, Funnel plot, Cumulative plot.

Mentions: Analysis of the heterogeneity: The Q statistic was 8.65 and I2 was 0% (p=0.470), supporting the assumption of homogeneity among the studies. Further, there is no sign of heterogeneity in the L’Abbé plot (Fig. 3), all the circles being grouped close together, independently of their size and baseline risk.


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.

Arteagoitia MI, Barbier L, Santamaría J, Santamaría G, Ramos E - Med Oral Patol Oral Cir Bucal (2016)

L'Abbé plot, Funnel plot, Cumulative plot.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4920465&req=5

Figure 3: L'Abbé plot, Funnel plot, Cumulative plot.
Mentions: Analysis of the heterogeneity: The Q statistic was 8.65 and I2 was 0% (p=0.470), supporting the assumption of homogeneity among the studies. Further, there is no sign of heterogeneity in the L’Abbé plot (Fig. 3), all the circles being grouped close together, independently of their size and baseline risk.

Bottom Line: We found no evidence of heterogeneity (I2=0%, p=0.470).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.

View Article: PubMed Central - PubMed

Affiliation: Servicio Cirugía Maxilofacial, Hospital Universitario de Cruces, Plaza de Cruces s/n, Barakaldo (Bizkaia), Spain, jsz@clinicaimd.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus