33. Maxillofacial Surgery

Procedure

Antibiotic

Dose

Route

Dosing Interval

Comment

Wisdom teeth removal +/- cavity surgery (no risk factors for developing endocarditis)

No prophylaxis required

If there is bone removal continue with amoxicillin po 500mg tds 5 days

Wisdom teeth removal +/- cavity surgery (low risk of endocarditis in susceptible patients)

Wisdom teeth removal +/- cavity surgery
(low risk of endocarditis in susceptible patients)

If there is bone removal continue with amoxicillin po 500mg tds 5 days

Wisdom teeth removal +/- cavity surgery
(high risk of endocarditis/ immunocompromised)

See Trust Guidelines on prevention of endocarditis in susceptible dental patients
(followed by 5 day course of amoxicillin po 500mg tds - if penicillin allergic consider the use of oral clindamycin )

Osteotomy

Amoxicillin
&
metronidazole

1g

500mg

IV

At induction

Followed by IV/Oral metronidazole 500m/400mg tds and amoxicillin 500mg tds for 5 days
SWITCH TO ORAL AS SOON AS POSSIBLE
If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg IV

Oncology patients undergoing maxillofacial surgery

Cefuroxime
&
metronidazole

750mg

500mg

IV

At induction

Continue with oral co-amoxiclav 625mg tds for 5 days. If there is evidence of infection / necrotic bone add metronidazole po 400mg tds. If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg QDS (IV/oral)

Facial Trauma

Cefuroxime
&
metronidazole

1g

500mg

IV

At induction

Continue with oral co-amoxiclav 625mg tds for 5 days. If there is evidence of infection / necrotic bone add metronidazole po 400mg tds. If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg QDS (IV/oral)

Procedure	Antibiotic	Dose	Route	Dosing Interval	Comment
Wisdom teeth removal +/- cavity surgery (no risk factors for developing endocarditis)	No prophylaxis required				If there is bone removal continue with amoxicillin po 500mg tds 5 days
Wisdom teeth removal +/- cavity surgery (low risk of endocarditis in susceptible patients)	Wisdom teeth removal +/- cavity surgery (low risk of endocarditis in susceptible patients)				If there is bone removal continue with amoxicillin po 500mg tds 5 days
Wisdom teeth removal +/- cavity surgery (high risk of endocarditis/ immunocompromised)	See Trust Guidelines on prevention of endocarditis in susceptible dental patients (followed by 5 day course of amoxicillin po 500mg tds - if penicillin allergic consider the use of oral clindamycin )
Osteotomy	Amoxicillin & metronidazole	1g 500mg	IV	At induction	Followed by IV/Oral metronidazole 500m/400mg tds and amoxicillin 500mg tds for 5 days SWITCH TO ORAL AS SOON AS POSSIBLE If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg IV
Oncology patients undergoing maxillofacial surgery	Cefuroxime & metronidazole	750mg 500mg	IV	At induction	Continue with oral co-amoxiclav 625mg tds for 5 days. If there is evidence of infection / necrotic bone add metronidazole po 400mg tds. If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg QDS (IV/oral)
Facial Trauma	Cefuroxime & metronidazole	1g 500mg	IV	At induction	Continue with oral co-amoxiclav 625mg tds for 5 days. If there is evidence of infection / necrotic bone add metronidazole po 400mg tds. If penicillin allergic (rash) use cefuroxime 750mg and metronidazole IV. If history of penicillin anaphylaxis use clindamycin 600mg QDS (IV/oral)