GUIDELINES: Antibiotic Prophylaxis in Oral Surgery for prevention of surgical site infection

These Clinical Practice Guidelines (CPG) were developed by a committee comprising six Oral Surgeons, one Periodontist, one Clinical Microbiologist, three Dental Public Health Specialists and one Pharmacist.

After development, the guidelines were scrutinized by an internal review committee who gave feedback primarily on the comprehensiveness of the guidelines and accuracy of the interpretation of evidences supporting the recommendations in the guidelines.

A respected clinician and academic was invited as external reviewer and provided useful feedback on the guidelines. The previous edition of the CPG on Antibiotic Prophylaxis against Wound Infection for Oral Surgical Procedures (August 2003) was used as a reference. 

Several changes have been made in these updated guidelines. Sections on periodontal surgery, cancer surgery and surgery in previously irradiated bone have been included. The section on trauma has been simplified.

There are also some changes in the choice and regime of the recommended antibiotics. In addition to the new and updated information, key messages are given where the available evidence is too weak to make a recommendation. 

Clinical audit indicators have been identified for the purpose of monitoring and evaluating outcomes and are recommended for use in individual centres. In reviewing these guidelines, publications from the year 2003 onwards were retrieved and scrutinized. 

A literature search was carried out using the following electronic databases: PubMed/MEDLINE; Cochrane Database of Systemic Reviews (CDSR); ISI Web of Knowledge and full text journal articles via the OVID search engine.

In addition, the reference lists of all relevant articles retrieved were searched to identify further studies. 

Free text terms or MeSH terms were used either singly or in combination to retrieve the articles (Appendix 1). Only literature in English was retrieved. Each article retrieved was appraised by at least two members. 

The selected articles were assigned their evidence level according to the U.S./Canadian Preventive Services Task Force guide and the key information in each article was presented in an evidence table.

These were then discussed during group meetings. Recommendations made were graded according to the Scottish Intercollegiate Guidelines Network (SIGN) guide. All statements and recommendations formulated were agreed upon by both the development group and review committee. 

The recommendations in this CPG were made taking into consideration both current scientific evidence as well as local circumstances. Where there was lack of or weak evidence, recommendations were made based on consensus of the group members. 

The draft guidelines were also posted on the Ministry of Health website for comments and feedback. The final draft of the CPG was presented to the Technical Advisory Committee for CPGs, the Health Technology Assessment (HTA) division and the CPG Council of the Ministry of Health, Malaysia for approval. 

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