Rotational use of antimicrobials is one of the strategies that have been suggested to reduce the development of drug-resistant bacteria. Cycling of homogeneous antimicrobial exposure is, however, unlikely to control the emergence of antimicrobial resistance. Penicillins and cephalosporins have been extensively used for therapeutic and prophylactic management of oral infection. The aim of the study was to investigate the clinical effects of azithromycin as prophylaxis on the prevention of postoperative infection in impacted mandibular third-molar surgery. The study design was a retrospective, single-center review. One (2.2%) of all 45 patients exhibited dry socket infection. In several categories, there was significant effectiveness of azithromycin in comparison with other antimicrobials, although there was no significant difference in the occurrence rate of dry socket infection. Azithromycin might be of value for prophylactic use in impacted mandibular third-molar surgery in which penicillins and cephalosporins were mainly used. Therefore, it might be available for one of the rotational agents.
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