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

M-I Arteagoitia, L Barbier, J Santamaría, G Santamaría, E Ramos, M-I Arteagoitia, L Barbier, J Santamaría, G Santamaría, E Ramos

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.

Conflict of interest statement

Conflict of interest statement: The authors have declared that no conflict of interest exist.

Figures

Figure 1
Figure 1
1. Risk of bias in studies included in the systematic review. - All the studies were considered low risk in terms of performance and detection bias, given that a double-blind design was a selection criterion for the meta-analysis. - In studies with a split-mouth design, it was considered that that there might be other sources of bias given the duration of the washout period (no more than 4 weeks in all cases).
Figure 2
Figure 2
Forest Plots. Overall forest plot: graphical representation of the estimates of the RRs and 95% CIs based on the samples in each of the studies, including both those that used amoxicillin and those that used amoxicillin/clavulanic acid, together with their relative weights. Amoxicillin forest plot. Amoxicillin/clavulanic acid forest plot.
Figure 3
Figure 3
L'Abbé plot, Funnel plot, Cumulative plot.

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Source: PubMed

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