Comparison of ceftriaxone with penicillin for antibiotic prophylaxis for compound mandible fractures

Purpose. The purpose of the study was to compare the efficacy and cost of two antibiotic regimens for prophylaxis of compound mandible fractures: 1 gm/day ceftriaxone and 2 million U penicillin G every 4 hours. Design. A prospective study of 90 patients with compound mandible fractures was performed. The patients were randomized to the two antibiotic regimens. The surgical procedures were performed by oral/maxillofacial surgery residents at a large urban training center. Standard treatment consisted of open reduction with either bone plates or wires, with all patients receiving 6 weeks of maxillomandibular fixation. The patients were monitored at 2-week intervals for 8 weeks by two of the authors, who were blinded to which antibiotic regimen the patient was assigned. Results. Two patients in each group had postoperative infections within the first 2 weeks of treatment. The infections resolved with local wound care, removal of internal fixation devices, and oral antibiotics. After resolution of the infection each patient had a malunion, which was managed without additional complications. The cost difference between the two treatment regimens was approximately $350 per day. Conclusion. Ceftriaxone was noted to be an efficacious and cost-effective treatment alternative to penicillin G for compound mandible fracture antibiotic prophylaxis.