Optimal Duration of Antibiotic Therapy for Space Infections in the Maxillofacial Region: A Systematic Review

TL;DR

This review examines the best length of antibiotic treatment for facial infections caused by tooth issues and finds that short courses of 2-5 days with drainage are effective.

Contribution

The study provides evidence-based guidance on optimal antibiotic duration for maxillofacial infections of dental origin.

Findings

Short-course antibiotic regimens (2-5 days) combined with drainage are effective for treating odontogenic maxillofacial infections.

Nine studies were included, with mixed quality of evidence due to varying risk of bias.

Further high-quality randomized trials are needed to standardize treatment protocols.

Abstract

Objective: This review aimed to examine and highlight the treatment protocols and optimal duration of antibiotic regimens used in managing maxillofacial space infections of odontogenic origin, along with the associated clinical outcomes. Materials and methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42024621000). A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies from January 2003 to October 2024 using relevant MeSH terms. Studies were selected based on PEO criteria, focusing on the antibiotic treatment protocols and duration for odontogenic maxillofacial space infections, with inclusion of original human research and exclusion of non-relevant or unclear studies. Two independent reviewers performed study selection, data extraction, and risk of bias assessments using the Cochrane RoB 2 and ROBINS-I tools, resolving disagreements through discussion. Results: After data extraction, 277 papers were initially identified. Following the removal of duplicates, 141 articles were screened, of which 64 were selected for full-text assessment and 55 were excluded with justification. Ultimately, nine studies met the inclusion criteria for this review. These included two prospective double-blinded randomized clinical trials (RCTs), two prospective RCTs, four retrospective studies, and one prospective study, all involving patients with dentoalveolar orofacial infections. Risk of bias (RoB) assessment using RoB 2 indicated that two RCTs had a high risk of bias, one had a low risk, and one raised some concerns. ROBINS-I assessment showed moderate risk of bias in three studies, while two were not evaluated. Conclusion: This review concludes that prompt incision and drainage combined with a short-course antibiotic regimen of two to five days is generally effective for managing odontogenic maxillofacial space infections, though further high-quality randomized trials are needed to standardize treatment protocols.

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