Use of topical antibiotics as prophylaxis in clean dermatologic procedures

Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 08/2011; 66(3):445-51. DOI: 10.1016/j.jaad.2011.02.005
Source: PubMed


Topical antibiotics are not indicated for routine postoperative care in clean dermatologic procedures, but may be widely used.
We sought to describe topical antibiotic use in clean dermatologic surgical procedures in the United States.
The 1993 to 2007 National Ambulatory Medical Care Survey database was queried for visits in which clean dermatologic surgery was performed. We analyzed provider specialty, use of topical antibiotics, and associated diagnoses. Use of topical antibiotic over time was analyzed by linear regression.
An estimated 212 million clean dermatologic procedures were performed between 1993 and 2007; topical antibiotics were reported in approximately 10.6 million (5.0%) procedures. Dermatologists were responsible for 63.3% of dermatologic surgery procedures and reported use of topical antibiotic prophylaxis in 8.0 million (6.0%). Dermatologists were more likely to use topical antibiotic prophylaxis than nondermatologists (6.0% vs 3.5%). Use of topical antibiotic prophylaxis decreased over time.
Data were limited to outpatient procedures. The assumption was made that when topical antibiotics were documented at procedure visits they were being used as prophylaxis.
Topical antibiotics continue to be used as prophylaxis in clean dermatologic procedures, despite being ineffective for this purpose and posing a risk to patients. Although topical antibiotic use is decreasing, prophylactic use should be eliminated.

10 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The main interests covered in this article are the determination of risk factors and incidence of surgical site infections in dermatosurgery and suggestions for rational use of antibiotic prophylaxis. A total of 3284 consecutive dermatosurgical interventions in 1088 patients were performed in our dermatosurgery department. Data regarding patient characteristics and perioperative course were prospectively collected and retrospective analysis of this data was performed. Association of perioperative parameters and postoperative surgical site infections was assessed by χ(2) -test. Rate of postoperative infections in our study was low (1.9%). Purulent surgical sites showed the highest incidence of severe postoperative infections (4.7%; P < 0.001). The lowest incidence of mild infections was seen in preoperatively clean surgical sites (0.8%; P < 0.001). All patients with severe infections and 68% patients with mild infections were older than 70 years. The head and neck and acral regions were the groups mostly affected by mild postoperative conditions (2.4% and 1.7%, respectively; P = 0.006). The frequency of mild and severe infections in procedures performed by experienced surgeons was lower than in procedures performed by less experienced surgeons (0.6% vs 3.1% in mild infections, 0.1 vs 0.8 in severe infections; P < 0.001). The main risk factors for postoperative infections were wounds in the head and neck region, lips and oral mucosa or acral regions, older age of patients, worse preoperative state of surgical sites and less experienced surgeons. In the majority of cases where risk factors were missing there was no need of antibiotic prophylaxis.
    The Journal of Dermatology 08/2013; 40(10). DOI:10.1111/1346-8138.12255 · 2.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Importance: Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists continue to prescribe them. The objective of our systematic review and meta-analysis was to critically assess the efficacy of topical antibiotics in terms of preventing postsurgical wound infections in the dermatology outpatient setting. Methods: PubMed, Embase, MD Consult, Science Direct, Springer Link, DynaMed, and Cochrane online medical databases were searched from 1980 to 2013. Results: Using random effects modeling, the pooled odds ratio of developing a postsurgical wound infection was 0.71 (95% CI, 0.42-1.19). Discussion: Pooled data of the four trials in the meta-analysis did not show a statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. In the setting of moist occlusive dressings, there is no statistically significant difference in prophylactic efficacy between applying and not applying ointment to surgical wounds. Wounds at increased risk of developing surgical site infections include wounds in diabetics, wounds located in certain anatomic regions, and wounds created by some surgical procedures. Conclusions: Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.
    Journal of Dermatological Treatment 03/2014; 26(2). DOI:10.3109/09546634.2014.906547 · 1.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.
    Annals of Dermatology 02/2015; 27(1):15-20. DOI:10.5021/ad.2015.27.1.15 · 1.39 Impact Factor

Similar Publications