179 Antibiotic Prophylaxis for Oral Lacerations: Practice in an Urban Emergency Department

Most of the studies to date that have attempted to examine the use of prophylactic antibiotics in patients with oral lacerations have been inadequately powered leading to inconclusive results. The lack of compelling available research has led to practice variation by emergency physicians. The purpose of this study was to examine the emergency physician practice of prescribing prophylactic antibiotics for patients who have oral lacerations in an urban emergency department (ED). A secondary outcome measure was the infection rate of those who were or were not prescribed antibiotics. This study was a retrospective chart review of a randomized selection of patients who presented to the ED between January 1, 2012 to December 31, 2012 with a discharge diagnosis of “open wound of lip, tongue, mouth, gum, face, buccal mucosa, or palate.” Patients were excluded if they did not have an oral laceration or if they had a preexisting infection. Data was collected from ED and oral surgery clinic medical records. Of the 200 charts reviewed, antibiotics including topical or systemic, were given in the ED to 63.5% (127/200) of patients. Of those patients, 43% (54/127) received only topical antibiotics, 28% (36/127) received only systemic antibiotics and 29% (37/127) were given topical and systemic antibiotics; 36.5% (73/200) received no antibiotics. There were 36/200 (18%) patients who returned for follow-up (either to the ED or the oral surgery clinic). Of those who returned, 11% (4/36) had an infection. One of the 4 patients who had an infection had been prescribed oral antibiotics. The remaining three patients had not been initially prescribed antibiotics. Therefore, the ratio of infections in patients prescribed antibiotics was 1/127 and the ratio of infection in patients not prescribed antibiotics is 3/73. Statistical analysis revealed a significant difference between these two independent proportions (one tailed P