Non-Cochrane · intervention · PM42138606
Clinical Outcomes of Adjunctive Corticosteroid Therapy Versus Standard Treatment Alone in Patients With Bacterial Facial Infections: A Systematic Review and Meta-Analysis.
Hussain Umer, Abbas Wajiha, Rahman Inayat Ur, et al. · Clinical and experimental dental research · 2026 · PubMed · doi:10.1002/cre2.70377
Findings
15 findings
| Population | ||||
|---|---|---|---|---|
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Risk of bias: moderate | MD -0.93 [-4.14, 2.27] GRADE not reported 4 studies |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Study design: non-randomized studies | MD -1.63 [-3.55, 0.28] GRADE not reported 8 studies |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Ethnicity: Asian | MD -1.87 [-5.90, 2.16] GRADE not reported 3 studies |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Ethnicity: American | MD -0.77 [-2.68, 1.15] GRADE not reported 6 studies |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Pre-treatment C-reactive protein (CRP) Pre-treatment | SMD 0.33 [0.09, 0.58] Low Downgraded: risk of bias 3 studies · 1271 participants |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge Unresolved: the two extractors disagree on this row. | MD -1.61 [-3.17, -0.05] Low Downgraded: risk of bias, inconsistency 10 studies · 13058 participants |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Risk of bias: serious | MD -2.65 [-6.23, 0.91] GRADE not reported 4 studies |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Intensive care unit (ICU) admission At discharge | OR 0.56 [0.25, 1.27] Very low Downgraded: imprecision 2 studies · 179 participants |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Risk of bias: low | MD -1.32 [-30.48, 27.85] GRADE not reported 2 studies |
| Patients with bacterial facial infections (orbital cellulitis, odontogenic and facial space infections, Ludwig's angina, periapical abscess) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs) or no steroids | Hospital stay (days) Until discharge · Hospital and clinical settings in multiple countries · Ethnicity: African | MD -5.75 [-8.19, -3.31] GRADE not reported 1 study |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Airway compromise At discharge | OR 0.17 [0.03, 101.01] Very low Downgraded: imprecision 2 studies · 27 participants |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Number of surgeries At discharge Unresolved: the two extractors disagree on this row. | OR 0.48 [0.17, 1.34] Low Downgraded: risk of bias, imprecision 7 studies · 10951 participants |
| Patients with bacterial facial infections (odontogenic/facial space infections, dental abscess, orbital cellulitis, Ludwig's angina) | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Study design: randomized trials | MD -1.65 [-23.09, 19.81] GRADE not reported 2 studies |
| Patients with orbital cellulitis | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Type of infection: orbital cellulitis | MD -1.53 [-3.38, 0.31] GRADE not reported 7 studies |
| Patients with odontogenic facial space infection | Adjunctive oral or intravenous corticosteroids plus standard treatment | Standard treatment alone (antibiotics, NSAIDs or no steroids) | Hospital stay (days) At discharge · Type of infection: odontogenic facial space infection | MD -1.88 [-9.62, 5.84] GRADE not reported 3 studies |
Included primary studies 14
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Baumann 2021 The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess. PMID:33483197 | 2021 | this review only | not stated | not extracted yet |
| Brameli 2018 Systemic corticosteroids may be beneficial for managing severe or refractory orbital cellulitis in children. PMID:29920768 | 2018 | this review only | Hospital stay (days); Pre-treatment C-reactive protein (CRP) | not extracted yet |
| Chen 2018 Intravenous Steroids With Antibiotics on Admission for Children With Orbital Cellulitis. PMID:28369021 | 2018 | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
| Christensen 2025 Is Postoperative Steroid Use Associated With Improved Outcomes in Severe Odontogenic Infections? PMID:40239711 | 2025 | this review only | Hospital stay (days); Pre-treatment C-reactive protein (CRP) | not extracted yet |
| Davies 2015 C-Reactive Protein As a Marker for Initiating Steroid Treatment in Children With Orbital Cellulitis. PMID:25393908 | 2015 | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
| Delbet-Dupas 2020 Does anti-inflammatory drugs modify the severe odontogenic infection prognosis? A 10-year's experience. PMID:32851983 | 2021 | this review only | Number of surgeries | not extracted yet |
| Ekaniyere 2020 O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation is significantly less frequent in ependymal tumours as compared to… PMID:20202118 | 2010 | this review only | Hospital stay (days) | not extracted yet |
| Foster 2018 Molecular Characterization of Staphylococcus aureus Isolates From Children With Periorbital or Orbital Cellulitis. PMID:28575438 | 2018 | this review only | not stated | not extracted yet |
| Gill 2022 Association Between Corticosteroids and Outcomes in Children Hospitalized With Orbital Cellulitis. PMID:34877598 | 2022 | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
| Kent 2021 The use of steroids in cervicofacial infections in UK OMFS departments: a Maxillofacial Surgery Trainees Research Collaborative (MTReC)… PMID:33205245 | 2021 | this review only | Pre-treatment C-reactive protein (CRP) | not extracted yet |
| Leszczynska 2021 Corticosteroids for Acute Orbital Cellulitis. PMID:34697218 | 2021 | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
| Pushker 2013 Role of oral corticosteroids in orbital cellulitis. PMID:23622565 | 2013 | this review only | Hospital stay (days) | not extracted yet |
| Suleman 2025 matched by author and year (probable) | NR | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
| Yen 2005 Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. PMID:16234700 | 2005 | this review only | Hospital stay (days); Number of surgeries | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with facial infections (odontogenic infections, facial space infections, dental abscesses, Ludwig's angina, orbital cellulitis) | 13,905 patients with orbital cellulitis (8 studies), odontogenic infections (5), periapical abscess (1), Ludwig's angina (1) (n=15 studies) |
| Intervention | Adjunctive oral or intravenous corticosteroids at any time point, any dose or duration | Dexamethasone (9 studies), prednisone, prednisolone, methylprednisolone and general corticosteroids, oral or intravenous |
| Comparison | No steroid treatment or standard treatment (antibiotics and NSAIDs) | Antibiotics alone or standard care without steroids; NSAIDs in one study; placebo in one RCT; surgical decompression in one study |
| Outcomes | Hospital stay, number of surgeries, airway compromise (primary); swelling, pain, inflammatory markers, additional interventions (secondary) | Hospital stay (10 studies), pre-treatment CRP (3), number of surgeries (7), ICU admissions (2), airway compromise (2) |
| Study designs | Randomized controlled trials and prospective or retrospective cohort/non-randomized comparative studies | 3 RCTs and 12 non-randomized studies (8 prospective, 4 retrospective) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |