Antibiotic practices in non-condylar mandibular fractures: A Maxillofacial Trainee Research Collaborative (MTReC) UK-Wide Survey

Abstract Background Non-condylar mandibular fractures are considered ‘open’ fractures and as such are considered to require prophylactic antibiotics. There is no overall consensus on the optimal regimen or choice of antibiotics in the pre and post-operative periods due to the lack of high-quality evidence. We set out to ascertain the current UK-wide practice of antibiotic prescribing for non-condylar mandibular fractures. Methods We used a web-based online survey (Google Forms). This was disseminated via email and social media platforms to Oral & Maxillofacial Surgery (OMFS) consultants and trainees of all grades. The questions were focussed on usual antibiotic practices and typical clinical management of non-condylar mandibular fractures. We gathered information on the pre-operative antibiotics, the perioperative period and the post-operative period. Answers were analysed using SPSS (version 26, IBM). Results We collected data from 50 different UK OMFS units representing a broad snap-shot of the national practice. The majority of responders were Speciality Trainee level (36%) followed by Dental Core Trainees (34%). 45/50 centres routinely admitted patients and pre-operative intravenous antibiotics were commenced on admission in 77/89 respondents, with intravenous as the chosen route in all cases. In the pre-operative period 81% prescribe co-amoxiclav. In 91% of cases open reduction internal fixation (ORIF) was conducted on the general emergency (CEPOD) operating lists, whilst dedicated OMFS trauma lists formed 9%. With respect to timing, 49% aimed to carry out ORIF within 24 hours from time of admission, 44% aimed for surgery within 24- 48 hours and 6% aimed for surgery on a semi-elective basis (≥48 hours). Post-operative antibiotics were prescribed routinely by 88% of responders. Conclusions Pre-operative intravenous prophylactic antibiotics are commonplace in non-condylar mandibular fractures. This UK-wide survey demonstrated significant variability in antibiotic prescribing practises, especially in the post-operative period. Most units still rely upon CEPOD emergency theatres to provide their capacity for providing ORIF to this patient group.