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Three Part Question

In [adults with non-contaminated lacerations] does [the application of topical antibiotics] reduce [the incidence of secondary infection, the length of time dressings are required and achieve a better cosmetic result]?

Clinical Scenario

A 26 year old man attends the emergency department with a simple laceration requiring suturing. You wonder whether application of a topical antibiotic ointment may promote healing and reduce incidence of infection.

Search Strategy

Medline 1966-07/02 using the OVID interface.
[({exp administration, topical OR topical therapy.mp} AND exp antibiotics OR antibiotic$.mp) AND exp ointments OR ointments.mp] AND [exp Staphylococcal infections OR exp Skin OR superficial wounds.mp OR exp Wound healing OR exp Wound infection OR exp " Wounds and Injuries"] LIMIT to human AND English.

Search Outcome

71 papers were found of which 70 were irrelevant or of insufficient quality for inclusion. The remaining paper is shown in the table below.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Dire DJ et al, 1995, USA	465 patients with minor uncomplicated soft tissue wounds necessitating suturing attending an emergency department. Puncture wounds, wounds over 12 hours old, underlying fracture or neurovascular complication, allergies to agents used, antibiotics within previous 7 days and pregnant or immunocompromised patients were excluded	Double blind randomised controlled trial	Evidence of infection	Antibiotic ointment is better at reducing infection than petrolatum alone	No mention of methods of randomisation Wounds treated differently initially Subjective measurements Patients responsible for own wound care Dubious recruitment strategy

Comment(s)

Although this study suggests that antibiotic ointment reduces incidence of infection there are a number of reasons at the moment why we would be reluctant to change current clinical practice. The intensive wound care used in the study may not mirror our own practice. Long term results and patients own assessment of outcome may be better indicators of the benefit of topical antibiotics, than the short-term effects measured in this trial.

Clinical Bottom Line

There is not enough evidence here to change current practice. A large multicentre study is indicated to provide more relevant answers.

References

1. Dire DJ, Coppola M, Dwyer DA, et al. Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED. Acad Emerg Med 1995;2(1):4-10.