In recent years, the increase in drug-resistant bacteria and associated infections has
become one of the major issues in the international community as adverse events
associated with the inappropriate use of antimicrobial agents. Although the frequency and
percentage of inappropriate use is currently unknown, it has been shown that at least 30%
of antimicrobials prescribed in the U.S. are inappropriately used. If no action is taken
against inappropriate antimicrobial use, it is estimated that 10 million people will die
annually worldwide from drug-resistant organisms by 2050, with an estimated 4.9 million
deaths related to drug-resistant organisms and 1.2 million deaths due to drug-resistant
organisms already estimated for 2019. In addition, while the development of new
antimicrobial agents has declined since the 1980s, the threat of new drug-resistant
organisms, especially in hospitals, has increased, and if antimicrobial agents are not
used appropriately, there is concern that there will be no effective antimicrobial agents
available to treat infections in the future. It is important to avoid such situations by
using antimicrobial agents, which are a limited resource, appropriately at this stage,
and appropriate use of antimicrobial agents is necessary to prevent drug resistance
(Antimicrobial Resistance: AMR).
Third molar extraction is the most commonly performed procedure in oral and maxillofacial
surgery. One of the main complications after third molar extractions is surgical site
infection (SSIs), which is reported to manifest as swelling, pain, abscess, and fever.
According to a Cochrane review of randomized controlled trials, the risk of SSIs after
third molar extraction in physically fit young patients is about 10%, but in patients
with low immunity before extraction, the risk increases up to 25%. Prophylactic
administration of antimicrobial agents has an important role in preventing SSIs. However,
the efficacy of antimicrobial prophylaxis against SSIs in third molar extractions is
controversial. While some studies have reported that antimicrobials are effective in
preventing SSIs after third molar extraction, others have reported that they are not.
Guidelines for third molar extraction vary widely in the duration of antimicrobial
administration (e.g., Japanese guidelines state a single dose to within 48 hours). In
clinical practice, the final decision lies with the surgeon, but this difference in
dosing period is a source of confusion. If the duration of administration could be
shortened without increasing SSIs, it would contribute to the current presentation of
AMR. Therefore, the purpose of this study is to examine the effect of different durations
and doses of penicillins, which are considered first-line drugs after third molar
surgery, on the prevention of SSIs.