Efficacy of amoxicillin or amoxicillin and clavulanic acid in reducing infection rates after third molar surgery: a systematic review and meta-analysis

OBJECTIVE: The current review was designed to assess the efficacy of amoxicillin (AMX) and amoxicillin-clavulanic acid (AMX-CLA) for reducing infection rates after third molar surgery. MATERIALS AND METHODS: PubMed, Embase, ScienceDirect, and Google Scholar were searched for double-blind randomized controlled trials (RCTs) assessing the efficacy of AMX/AMX-CLA for infection control after third molar surgery. RESULTS: 13 RCTs were included. Our meta-analysis demonstrated a statistically significant reduced risk of infections with AMX/AMX-CLA (RR: 0.29. 95% CI: 0.18, 0.45 I-2 =0% p<0.00001). The meta-analysis demonstrated that the risk of infections was significantly reduced only in parallel-arm trials but not in splitmouth trials. Sub-group analysis based on antibiotic type indicated that the risk of infections was reduced with both AMX and AMX-CLA. A subgroup analysis based on the timing of AMX/AMX-CLA administration indicated that the risk of infections was significantly reduced with both preoperative (RR: 0.41, 95% CI: 0.21. 0.81 1 2 =0% p=0.01) and postoperative (RR: 0.18, 95% CI: 0.09. 0.35 1 2 =0% p<0.00001) administration of AMX/AMX-CLA. Meta-analysis indicated no increased risk of adverse events with the use of AMX/AMX-CLA (RR: 1.47, 95% CI: 0.41, 5.22 1 2 =77% p=0.55). CONCLUSIONS: The use of AMX/AMX-CLA is associated with a significant reduction in the risk of infections after impacted third molar surgery. The risk of infections is reduced with both AMX and AMX-CLA. Our results also indicated that the infection risk was reduced with preoperative and postoperative antibiotic administration and there is no significant increase in the risk of antibiotic-related adverse events.