COMMENTARY

Topical Antibiotics: Yes or No for Surgical-Site Infections?

Albert B. Lowenfels, MD

September 14, 2017

Should topical antibiotics be used to prevent surgical wound infections? The authors of a study published in the British Journal of Surgery^[1] carefully reviewed all available publications focusing on 14 randomized trials (6466 patients). Wound categories included clean, clean-contaminated, and contaminated wounds.

The conclusion from eight studies was that, compared with no topical antibiotics, topical antibiotics use decreased surgical-site infections (risk ratio, 0.61; 95% confidence interval [CI], 0.42-0.87). Five studies compared topical antibiotics with topical antiseptics, such as compounds containing iodine; the results favored topical antibiotics (risk ratio, 0.49; 95% CI, 0.30-0.80).

Viewpoint

This report summarizes a previously published Cochrane report covering the same topic.^[2] The overall conclusion is that topical antibiotics do offer some benefits compared with nonuse or compared with topical antiseptics. The evidence regarding antibiotic ointments and allergic reactions was inconclusive because of the small sample sizes in the reported studies. The authors suggest that for clean wounds, the evidence for the use of topical antibiotics is less convincing.

Current guidelines from the National Institute for Health and Care Excellence state that "topical antibiotics should not be used in wounds healing by primary intention." Most other current reviews do not recommend topical antibiotics to prevent wound infections. The 2017 Centers for Disease Control and Prevention guidelines for preventing surgical-site infections recommend topical antibiotics only for clean or clean-contaminated wounds.^[3]

In summary, this report provides evidence supporting surgeons who do use topical antibiotics to avoid surgical-site infections.

Follow Medscape Surgery on Twitter for more surgery news: @MedscapeSurgery

References

Heal CF, Banks JL, Lepper P, Kontopantelis E, van Driel ML. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection. Br J Surg. 2017;104:1123-1130. Abstract
Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev. 2016;11:CD011426.
Berríos-Torres SI, Umscheid CA, Bratzler DW, et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017 May 3. [Epub ahead of print]

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Topical Antibiotics: Yes or No for Surgical-Site Infections? - Medscape - Sep 14, 2017.