Does administration of oral versus intravenous antibiotics for third molar removal have an effect on the incidence of alveolar osteitis or postoperative surgical site infections?

Abstract Purpose To compare the incidence of postoperative alveolar osteitis (AO) and surgical site infections (SSI) among two separate cohorts of subjects undergoing elective third molar removal: those that received postoperative oral (PO) antibiotics and those that received perioperative intravenous (IV) antibiotics. Materials and Methods A retrospective cohort study of all subjects aged 14 to 30 undergoing elective outpatient third molar removal under a single surgeon’s service over a 12-year period was completed. Subjects undergoing third molar removal during the first 72 months received postoperative PO antibiotics alone. Subjects undergoing third molar removal during the second 72 months received perioperative IV antibiotics alone. The primary predictor variable for the study was the antibiotic regimen employed at the time of third molar removal. The primary outcome variable was the postoperative development of AO or SSI. Covariates included age and gender. Univariable and multivariable regression models assessed for associations between the antibiotic regimen employed and the presence of AO and SSI. Results The study sample consisted of 1895 subjects (1020 subjects receiving postoperative PO antibiotics and 875 subjects receiving perioperative IV antibiotics). Among subjects receiving postoperative PO antibiotics, 6.4% developed AO an average of 5.7 days following the procedure and 2.6% developed SSI an average of 23.2 days following the procedure. Among subjects receiving perioperative IV antibiotics, 5.5% developed AO an average of 6.2 days following the procedure and 3.3% developed SSI an average of 18.2 days following the procedure. No statistically significant associations between the antibiotic regimen employed and the presence of AO or SSI were identified in either univariable or multivariable analyses. Among the postoperative PO antibiotic cohort, older age (p