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Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.14.2 Third molar surgery.<br />

Author<br />

Year<br />

Reference<br />

Country<br />

Study<br />

design<br />

Population<br />

characteristics<br />

Intervention<br />

Method<br />

Number indi<strong>vid</strong>uals<br />

Control<br />

Number<br />

indi<strong>vid</strong>uals<br />

Results<br />

Withdrawal<br />

Drop outs<br />

Study quality<br />

and relevance<br />

Comments<br />

Arteagoitia<br />

2005<br />

[8]<br />

Spain<br />

RCT<br />

Double<br />

blind<br />

Removal of one 3rd<br />

mandibular molar.<br />

Well described.<br />

Follow-up 7 days<br />

and 8 weeks<br />

I: Amoxicillin/clavulanic acid<br />

500/125 x 3 x 4 days. Given<br />

directly after surgery for<br />

4 days (n=261)<br />

C: Placebo x 3 x 4 days.<br />

Given directly after<br />

surgery for 4 days<br />

(n=233)<br />

SSI + alveolitis<br />

I: 5/261<br />

C: 30/233<br />

NNT 10<br />

Complications<br />

I: 14 mild<br />

C: 2 mild<br />

NNH 28<br />

2/261<br />

intervention.<br />

2/233 placebo<br />

High<br />

Power estimated.<br />

Well defined study<br />

Bergdahl<br />

2004<br />

[12]<br />

Sweden<br />

RCT<br />

Double<br />

blind<br />

Surgical removal of<br />

1 or 2 partly erupted<br />

3rd molars. Inclusion<br />

criteria described<br />

I: Partly erupted 3rd molars,<br />

1 or 2. Single dose 1 600 mg<br />

metronidazole. 45 min before<br />

surgery (n=59)<br />

C: Placebo 45 min<br />

before surgery (n=60)<br />

Alveolitis<br />

I: 10/59<br />

C: 13/60<br />

No sign difference<br />

1/20 no side<br />

effects<br />

High<br />

Power estimated,<br />

well designed study<br />

Halpern<br />

2007<br />

[14]<br />

USA<br />

RCT<br />

Blinded<br />

Surgical removal of<br />

at least 1 impacted<br />

3rd mandibular molar.<br />

Well described<br />

I: Antibiotics iv (penicillin<br />

1 500 units/kg or clindamycin<br />

600 mg (n=59)<br />

C: Placebo 0.9% NaCl<br />

(n=59)<br />

SSI<br />

I: 0/59<br />

C: 5/59<br />

p=0.03<br />

4/122 (3.3%) High<br />

Good and well<br />

defined study.<br />

Power estimated<br />

Hedström<br />

1990<br />

[9]<br />

Sweden<br />

RCT<br />

Double<br />

blind<br />

Surgical removal<br />

of partially erupted<br />

3rd mandibular molar<br />

I: Metronidazole 400 mg single<br />

dose (n=40)<br />

C: Placebo single dose<br />

(n=40)<br />

Alveolitis<br />

I: 6/40<br />

C: 15/40<br />

No drop outs<br />

Moderate<br />

Good study.<br />

Relatively poor<br />

external validity<br />

Kaczmarzyk<br />

2007<br />

[15]<br />

Poland<br />

RCT,<br />

3 groups<br />

Surgical removal of<br />

3rd molar. Inclusion<br />

and exclusion criteria<br />

described<br />

I1: Clindamycin 600 mg +<br />

placebo x 3 x 5 (n=31).<br />

I2: Clindamycin 600 mg +<br />

300 mg x 3 x 5 (n=28)<br />

C: Placebo + placebo<br />

x 3 x 5 (n=27)<br />

SSI or alveolitis<br />

No statistical<br />

difference between<br />

the actively treated<br />

groups. No difference<br />

compared to placebo<br />

14/100 (14%) Moderate<br />

Good and acceptably<br />

defined<br />

study. Power<br />

not estimated<br />

The table continues on the next page<br />

536 antibiotikaprofylax <strong>vid</strong> <strong>kirurgiska</strong> <strong>ingrepp</strong> KAPITEL 4 • den systematiska litteraturöversikten<br />

537

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