Is Clindamycin Effective in Preventing Infectious Complications After Oral and Maxillofacial Surgical Procedures – A Systematic Review and Meta-Analysis

Abstract

Objective: To determine the effect of clindamycin in the prevention of infection after oral and maxillofacial surgery.

Material and Methods: This systematic review and meta-analysis followed the PRISMA statement, the PICO-framework and included only randomized controlled clinical trials. In all studies clindamycin was administered to prevent infections in patients who underwent oral surgery.  An independent researcher conducted the search, data extraction and risk of bias assessment. Included studies were classified by the type of oral surgery. Besides, data of patients, procedures and outcome variables were collected. The combined results were expressed as proportions for the dichotomous data assessed as risk ratio using Mantel-Haenszel test at 95% confidence intervals (CIs) at P<0.05 considered as significant. Chi-square and Tau-square were used to assess whether the observed difference was homogeneous or heterogeneous among the studies. Statistical heterogeneity was assessed by the I² test at α=0.10.

Results: Five studies were included in the pooled assessment. A total of 318 participants were in clindamycin and control groups. The pooled relative risk obtained was 0.29[0.16, 0.51]. As the relative risk is less than 1, it can be implied that use of clindamycin is associated with reduction of post-operative inflammatory complications. Overall, the results were statistically significant (p<0.05) with low heterogeneity (I2=20%).

Conclusion: It can be implied that use of clindamycin is associated with reduction of post-operative inflammatory complications. The null hypothesis that oral clindamycin is minimally effective in preventing infection in third molar surgery regardless of the dosage used may be accepted.

Clinical Relevance: There is a lack of high quality evidence supporting the prescription of clindamycin to prevent infections after oral surgery, despite being frequently prescribed as an alternative for penicillin-allergic patients. Oral clindamycin has been shown to be very minimally effective after third molar extractions.