Abstract
<title>Abstract</title> <p> <bold>Objectives</bold> Clindamycin antibiotic prophylaxis has been associated with more postoperative infections than amoxicillin in general surgery and implantology, but data specific to pre-implant bone augmentation remain limited. This study evaluated the association between antibiotic prophylaxis with clindamycin versus amoxicillin and 6-month postoperative infection, overall complication and failure of pre-implant alveolar bone augmentation procedures. <bold>Materials and Methods</bold> We conducted a retrospective cohort study including patients who received amoxicillin or clindamycin (in cases of self-reported penicillin-allergy) as antibiotic prophylaxis for pre-implant bone grafting conducted in a hospital setting between January 2021 and June 2024. Patients were followed for 6 months, and outcomes included surgical‑site infection, wound dehiscence, and graft failure. Analyses included cumulative-incidence estimates, Kaplan-Meier survival curves, and Cox regression models adjusted for confounders. <bold>Results</bold> A total of 143 patients were analyzed; 23 received clindamycin and 120 received amoxicillin. The postoperative infection rate was 43% (10/23) in the clindamycin group and 9% (11/120) in the amoxicillin group (p < 0.0001). Clindamycin-treated patients had a significantly higher risk of overall complications (infection, dehiscence or failure) over time (adjusted HR = 3.94; 95% CI, 1.93–8.06; p < 0.001) compared with patients receiving amoxicillin. <bold>Conclusions</bold> In penicillin-allergic patients undergoing pre-implant alveolar bone augmentation, clindamycin antibiotic prophylaxis was associated with a higher risk of postoperative infection, overall complication, and failure than amoxicillin. <bold>Clinical Relevance</bold> These results question the routine use of clindamycin as a default alternative in penicillin-allergic patients undergoing pre-implant bone grafting. Systematic preoperative allergy assessment and of alternative regimens (e.g., azithromycin) may be considered into clinical decision-making. </p>