Do Facial Fractures Require Antibiotic Prophylaxis?

Probably not, but we still aren't well-informed by these data.

Antibiotic prophylaxis occurs quite a bit following traumatic injuries – wounds, open fractures, bites, et cetera. Which ones truly required antibiotics? When are they conclusively unnecessary?

This is just a multicenter observational study in which 19 trauma centers reported detailed data regarding the descriptive features of facial fractures, antibiotic use, and post-injury infectious complications.

Here’s the topline result:

Oh no! Antibiotic administration was associated with a higher rate of infectious complications! Stop the antibiotics!

(no)

But, clearly, when clinicians thought it appropriate to withhold prophylactic antibiotics – it was. The harder question to answer is in which of the ~36% of patients receiving antibiotics could they safely have been avoided. Unfortunately, there are not nearly enough infections, overall, to truly analyze contributing factors to those who did become infected – and their signals of risk such as mandible fracture, motorcycle crash, gunshot wound, and complex soft-tissue repair have such wide confidence intervals as to be unreliable.

A randomized, placebo-controlled trial would help determine which patients, specifically, are at elevated risk – but would require substantial statistical power to discern a difference in a likely very-low event rate.