2019 年 45 巻 5 号 p. 254-261
Third-generation oral cephalosporins are broad-spectrum antimicrobial agents and constitute one of the most used antibiotic classes in Japan. In the “National Action Plan on Antimicrobial Resistance (AMR),” the Japanese government declared implementation of efforts to reduce the use of oral cephalosporins by 50％ by 2020, compared to 2013. Antimicrobial resistance generally occurs due to inappropriate use or low-dosage exposure to antibiotic agents. Therefore, the choice of appropriate antibiotics is essential for implementing antimicrobial stewardship. To evaluate the prophylactic effects of antibiotics in impacted mandibular third molar surgery, we compared the rate of surgical site infection (SSI) in patients who were administered cefcapene-pivoxil (CFPN-PI) orally with that in patients who received amoxicillin (AMPC) orally. We conducted a retrospective study by reviewing the medical charts of patients from Hokkaido University Hospital from April 2016 to March 2017. The patients evaluated were classified into two groups: the AMPC group (n = 164) and the CFPN-PI group (n = 129). The SSI ratio of the CFPN-PI group was significantly higher than that of the AMPC group (CFPN-PI group, 11.6％ (15/129); AMPC group, 2.4％ (4/164); P = 0.002). Multivariate logistic regression analysis demonstrated that “use of CFPN-PI for prophylactic treatment” and “hospitalization after surgery” were independent factors related to the onset of SSI following impacted mandibular third molar surgery. These results demonstrated that AMPC was more effective than CFPN-PI in the prevention of SSI after impacted mandibular third molar surgery, and its regulated dosage can effectively contribute to the optimal use of antimicrobial prophylactic treatment.
