Are Antibiotics Needed For Facial Fractures?
Date First Published:
November 29, 2025
Last Updated:
November 29, 2025
Report by:
Brode Breuker MD, Megan S. Courtley MD, Senior EM resident, EM faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones, MD, Research Director
Three-Part Question:
[In adult patients presenting to the emergency department with non-operative facial fractures], do [prophylactic antibiotics] compared to [standard therapy] reduce [fracture-associated infectious complications]?
Clinical Scenario:
A 28-year-old male presents to the emergency department after blunt facial trauma. He works at a construction site and a heavy beam struck his face. Your workup demonstrates maxillary fractures, and plastic surgery recommends non-operative management of these fractures. You wonder if antibiotic administration would help prevent facial fracture associated infection.
Search Strategy:
Medline 1966-09/25 using PubMed, Cochrane Library (2025), and Embase
Search Details:
(Antibiotic prophylaxis AND Facial ones/injuries). LIMIT to adults AND English language
Outcome:
Seven articles were identified; two address the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial Mian RK, Grossman Verner HM, et al. April 2025 USA | Adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. | Logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications. | Facial fracture-associated infectious complications within 30 days postinjury. Secondary outcomes included hospital LOS, ICU LOS, days on ventilator, admission status, discharge disposition, and 30-day readmission. | Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). | The observational nature of this study limits our ability to establish causality. The variability in antibiotic prescribing practices across participating centers and differences in number, types, and strengths of antibiotics may introduce potential biases. In addition, actual compliance and treatment adherence of patients with the prescribed antibiotic regimens remains unknown. The low number of outcome events also limited the study’s power to detect true effects |
| Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures. Forrester JD, Wolff CJ, Choi J, et al. April 2021 USA | Adults (>18) with nonoperative facial fractures after trauma. Mandibular and open fractures were excluded. | Systematic review identified 3 studies. Three groups of subjects were categorized on the basis of the duration of antibiotic administration, namely, none, shortterm (1–5 days), and long-term (more than five days). |
Facial soft tissue infections and Clostridioides difficile | Only moderate- to low-quality evidence was identified. No patients in any study developed an infectious complication of the head or neck, and one patient in one study had an infectious complication that could have resulted from antibiotic administration. | Retrospective design, small patient numbers in subgroups, variability in antibiotic regimens, and potential selection bias in determining short versus extended antibiotic courses. |
| colitis, purulent nasal discharge, head or neck infections |
Author Commentary:
A prospective multicenter observational study and a Clinical Practice Guideline that reviewed applicable studies showed that prophylactic antibiotics in adults with non-operative facial trauma do not significantly reduce infection risk. Administration of prophylactic antibiotics is associated with increased cost and risk of antibiotic-associated complications such as C. Difficile infection and other adverse drug events. Further research with randomized controlled trials with larger sample sizes may improve the quality of evidence.
Bottom Line:
There is no clear benefit to antibiotic administration in patients with non-operative midface or upper face or mandibular facial fractures after trauma, and there is a potential risk and cost associated with antibiotic administration.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Mian RK, Grossman Verner HM, et al.. Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial
- Forrester JD, Wolff CJ, Choi J, et al.. Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures.