Amoxicillin vs third-generation cephalosporin for infection prophylaxis after third molar extraction

Misuzu Sato*, Hayato Yamana, Sachiko Ono, Miho Ishimaru, Hiroki Matsui, Hideo Yasunaga

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Although amoxicillin is the first-line prophylactic drug for impacted mandibular third molar extraction, third-generation cephalosporins are widely prescribed in Japan. The lack of real-world evidence may be one reason for this inappropriate use. We evaluated differences in the incidence of surgical site infection between amoxicillin and third-generation cephalosporins for impacted mandibular third molar extraction. Methods: Using the JMDC Claims Database, we identified dental visits with fully or horizontally impacted mandibular third molar extraction from April 2015 to March 2020. One-to-one propensity-score matching was conducted between amoxicillin and third-generation cephalosporin groups. The incidence of surgical site infection following extraction was compared in the matched pairs using McNemar's test. Results: We identified 109,266 dental visits, including 39,514 (36.2%) patients who received amoxicillin and 69,752 (63.8%) patients who received third-generation cephalosporins. In the 39,514 matched pairs, the incidence of surgical site infection was 3.5% (n = 1399) for amoxicillin group and 3.7% (n = 1467) for third-generation cephalosporin group (p = 0.003). Conclusions: Amoxicillin was associated with a lower incidence of surgical site infection after impacted mandibular third molar extraction compared with third-generation cephalosporins. This result supports current guidelines and strengthens the importance of disseminating and implementing antimicrobial resistance control in dentistry.

Original languageEnglish
JournalOral Diseases
DOIs
Publication statusAccepted/In press - 2022
Externally publishedYes

Keywords

  • antimicrobial resistance
  • impacted mandibular third molar
  • propensity-score matching
  • surgical site infection prophylaxis
  • tooth extraction

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Dentistry(all)

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