Wednesday, July 24, 2024

Topical Antibiotics For Wound Infection

Risk Of Bias In Included Studies

Should I use a topical antibiotic?

A summary of the assessment of risk of bias based on the criteria outlined in Higgins 2011 is given in Figure 2 and Figure 3. Additionally a brief descriptive analysis of the studies is provided below. One of the authors had a conflict of interest regarding assessment of a study , and an alternative author rated this study for risk of bias. In general, the overall methodological quality of the included studies was relatively poor. We classified studies as being at high risk of bias if they were rated as ‘high risk’ for any one of the three risk of bias criteria which we had specified in the protocol. A total of seven studies were deemed to be at high risk of bias , five were at unclear risk of bias , and two at low risk of bias .

In four studies both the participants and personnel were reported to be blinded , and this could be verified in three studies . In three studies either just the participants , or just the personnel , were blinded.

Blinding of outcome assessment

In five studies the outcome assessor was blinded to treatment allocation , while in the remaining nine studies it was unclear if the outcome assessor was blinded.

Blinding of participants, personnel and outcome assessor

Topical Antibiotic In The Wound

Topical Antibiotics are medicines in the form of cream & ointment applied directly to the skin for destroying or inhibiting the growth of susceptible bacteria. the primary role of Topical Antibiotic is to reduce the microbial contaminant exposure after the surgery.

The presence of micro-organisms including Bacteria within wound tissue after surgery can result in surgical site infections and delays the healing process. And, Topical Antibiotics are medicines in the form of cream & ointment applied directly to the skin for destroying or inhibiting the growth of susceptible bacteria. In this way, they help you prevent surgical site infection. Its more beneficial to employ antibiotics topically rather than intravenously or orally. Since topical antibiotics act only on a particular area of the skin where they are applied, hence, there is less likelihood of undesired results which may affect the whole body.

Major approaches for using topical antibiotic:

Finally, it can be said that the primary role of Topical Antibiotic is to reduce the microbial contaminant exposure after the surgery. Therefore, experts choose to apply the same on the infected skin area and thus prevent the wound infection. However, if you are also suffering from wound infection and want to get effective treatment, approaching a surgeon will be great. Withholding ample experience and expertise in the field, they will surely provide you with expected results!

Why It Is Important To Do This Review

Rationalising the use of antibiotics is important in order to reduce the risk of antibiotic resistance. The evidence for use of topical antibiotics is conflicting, and therefore a systematic review of trials is important to guide clinical practice. In some countries, such as the USA, topical antibiotics are available overthecounter, whereas in others they are only available when prescribed by a doctor. The effectiveness of this treatment is therefore important to consumers, as well as health practitioners. Better information about effectiveness could assist in rationalising use and contribute to controlling development of antibiotic resistance in the community.

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Neosporin Original First Aid Antibiotic Ointment With Bacitracin Zinc For 24

  • Contains heliderm technology that provides a nourishing environment for skin to heal, resulting in healthier looking skin after use.
  • Formulated with neomycin sulfate, bacitracin zinc and polymyxin b antibiotic ingredients to provide 24-hour infection protection for minor wounds.
  • .5-ounces of neosporin original topical antibiotic ointment by the number-one doctor recommended brand for treating minor cuts, scrapes and burns.
  • To use, apply a small amount of the first-aid antibiotic ointment to the affected area one to three times daily.
  • First-aid ointment nourishes skin to minimize the appearance of scars after healing.

Side Effects Interactions And Warnings

Topical antibiotic products available for treating chronic ...

Most people tolerate both Bacitracin and Neosporin well, but a small number of people will be allergic to either drug. An allergic reaction can cause a rash or itching. In rare cases, both drugs can cause a more serious allergic reaction. This can cause trouble breathing or swallowing.

Neosporin can cause redness and swelling at the wound site. If you notice this and arent sure if its an allergic reaction, stop using the product and call your doctor right away. If you think your symptoms are life-threatening, stop using the product and call 911. However, these products dont typically cause side effects.

Mild side effects

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When Is Tetanus Prophylaxis Needed For Minor Wounds

The Centers for Disease Control and Prevention recommends that tetanus toxoid be administered as soon as possible to patients who have no history of tetanus immunization, who have not completed a primary series of tetanus immunization , or who have not received a tetanus booster in the past 10 years.25 Tetanus immunoglobulin is also indicated for patients with puncture or contaminated wounds who have never had tetanus immunization.26

Practice Forumconsidering A New Domain For Antimicrobial Stewardship: Topical Antibiotics In The Open Surgical Wound

The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs , which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.

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Antibiotics Recommended For Infected Wounds

An infection is the growth of a parasitic organism, also called a germ, within the body.The onset of an infection is sudden, causing pain and swelling around the wound. Those germs, more commonly bacteria, attach to the tissues preventing the wound from healing.

The bacteria can also enter the blood through the vein and cause a severe infection or sepsis. The antibiotic is chosen based on the bacteria present. Oral antibiotics are taken by mouth, while IV antibiotics are administered through a needle directly into the bloodstream.

Ideal Properties Of Wound Dressings

Topical antimicrobials to treat skin infections

To address the health issue associated to wound infections, different forms of wound dressings have been developed in order to protect the wound from contamination and also to accelerate wound healing. Lately, traditional wound dressings which passively offer wound safety, have been substituted by innovative dressings that are proficient in providing a favorable environment and distributing active ingredients to the wound to facilitate wound healing. In this respect, a plethora of materials and combinations, both synthetic or natural, have been utilized, with numerous formulations and properties that make them appropriate for the management of a specific wound. Based on their nature of action, wound dressings are classified into three main groups: inert/passive, bioactive, and interactive .

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Antibiotics For Wound Infection

Jennifer Nelson

Jennifer Nelson

Jennifer is a contributing health writer who has been researching and writing health content with PlushCare for 3 years. She is passionate about bringing accessible healthcare and mental health services to people everywhere.

Dr. Katalin Karolyi

Dr. Katalin Karolyi

Katalin Karolyi, M.D. earned her medical degree at the University of Debrecen. After completing her residency program in pathology at the Kenezy Hospital, she obtained a postdoctoral position at Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida.

What Can We Conclude About Topical Antimicrobial Therapy For Chronic Wounds

Recommended Approach to Using Topical Antimicrobials for Treating Chronic Wounds in Various Clinical States

The main arguments against using topical antiseptics are the lack of adequate proof of efficacy and residual concerns about their potential toxicity to healing wounds. A compound’s toxicity risk depends on the particular formulation, concentration of active ingredient, and duration of exposure. Newer formulations and methods of applying topical antiseptics appear to reduce the risk. Antiseptics should not be used in solutions, because they are more likely to cause cell damage and have no demonstrated benefit over saline irrigation . Newer topical creams, ointments, gels, and dressings appear to provide adequate, sustained, and apparently nontoxic levels of antiseptics. Unfortunately, there is little information on systemic absorption of the agents, and evidence of clinical efficacy is meager. Thus, clinicians should currently use these products very selectively and only for a short duration. Investigators and the industry are seeking other ways to deal with chronic wound infections, including various innovative nonantimicrobial approaches. In light of the size and importance of the problem of chronic wound infection, we expect crude empiricism to continue to give way to creative entrepreneurship.

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Topical Antibiotics For Infected Wounds: A Review Of The Clinical Effectiveness And Guidelines

Rapid Response Report: Summary with Critical Appraisal

Tara Cowling and Sarah Jones.

Copyright Act

Given the dearth of evidence that clearly indicates the benefits or detriments of using topical antibiotics to treat infected wounds, several differing opinions on their use have surfaced over the years, many of them noting the limitations of the current literature. For instance, some authors suggest using topical antibiotics in addition to systemic therapy, despite the literature not demonstrating a clinical advantage, whereas other sources caution against the use of topical antibiotics for treatment of infected, ischemic wounds altogether, given the scarcity of supporting evidence. Overall, topical antibiotics are suggested for use on infected wounds only in instances where a wounds bioburden is interfering with healing and when there is an increased risk of serious outcomes. Given that many of the research papers frequently cited in this area have been published in the 1980s, the purpose of this review is to examine the recently published evidence on the clinical effectiveness of topical antibiotics for treatment of infected wounds.

When Does A Wound Require Hospitalization Or Referral To A Wound Care Specialist

Topical antibiotic products available for treating chronic ...

Indications for Hospitalization and Referral for Wounds


Poorly controlled diabetes mellitus or peripheral vascular disease immunocompromised

Severe cellulitis

Severe or circumferential burns, or burns to the face or appendages

Wounds affecting joints, bones, tendons, or nerves

Wounds to large areas of the body

Wounds to the face

Information from references 28 through 30, 36, 38, and 39.

Indications for Hospitalization and Referral for Wounds


Poorly controlled diabetes mellitus or peripheral vascular disease immunocompromised

Severe cellulitis

Severe or circumferential burns, or burns to the face or appendages

Wounds affecting joints, bones, tendons, or nerves

Wounds to large areas of the body

Wounds to the face

Information from references 28 through 30, 36, 38, and 39.

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What Types Of Topical Antimicrobials Are Available

Disinfectants are agents with activity against virtually all disease-causing microorganisms, including spores they are used primarily for sterilizing inanimate surfaces and may be toxic to tissues. Most topical antimicrobials can be divided into 1 of 2 major groups:

Antiseptics. Antiseptics are disinfectants that can be used on intact skin and some open wounds to kill or inhibit microorganisms. They often have multiple microbial targets, a broad antimicrobial spectrum, and residual anti-infective activity but are often toxic to host tissues .

Antibiotics. Antibiotics are chemicals produced either naturally or synthetically that in dilute solution inhibit or kill other microorganisms. They usually act on one specific cell target, have a narrower spectrum of activity, are relatively nontoxic, and are more susceptible to losing their effectiveness to bacterial resistance.

Topical Antiseptic Products Available for Treating Chronic Wounds

Topical Antibiotic Products Available for Treating Chronic Wounds

Characteristics Of The Included Trials And Patients

shows the PRISMA flow diagram. The initial search strategy yielded 7157 studies, and after removing the duplicates and non-RCTs, 5057 studies were eligible for title and abstract screening. Seventy-two full-text articles were retrieved and, after further exclusions, 13 trials with complete data were included in the meta-analysis.

Flowchart of study selection for systematic review and meta-analysis

Twelve trials compared topical antibiotics to placebo, paraffin, petrolatum, and other non-antibiotic ingredients,, and one trial compared topical antibiotics to placebo and antiseptic agents. Regarding type of surgery, there were five trials in dermatological surgery, one in abdominal surgery, two in orthopaedic surgery,, two in spinal surgery,, one in ocular surgery, and two in cardiothoracic surgery,. Most trials enrolled clean wounds ,, and only one trial enrolled clean-contaminated wounds. The administration of topical antibiotics included a nasal administration with mupirocin preoperatively,, vancomycin powder intraoperatively, and other topical applications postoperatively,,,. The use of prophylactic antibiotics before surgery in the included trials was inconsistent, and only seven used i.v. prophylactic antibiotics,, . Other perioperative management related to SSI and definition of outcomes varied among these trials .

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How Are Wound Infections Diagnosed And Treated

Symptoms of infection may include redness, swelling, warmth, fever, pain, lymphangitis, lymphadenopathy, and purulent discharge.2729The treatment of wound infections depends on the severity of the infection, type of wound, and type of pathogen involved. Treatment may include debridement and wound dressings that promote granulation, tissue preservation, and moisture. Empiric antibiotic treatment should be based on the potentially causative organism. Superficial mild infections can be treated with topical agents, whereas mild and moderate infections involving deeper tissues should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics.30,31Cultures should be obtained for wounds that do not respond to empiric therapy, and in immunocompromised patients.30

What Causes Wound Infections

Natural Antibiotic Ointment

Your skin protects your body from various pathogens. A wound is an opportunity for bacteria and other microorganisms to enter your body and cause problems like inflammation and tissue damage. An infection can start in a wound within a couple of days. The risk of infection is present until the wound heals.

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Data And Outcome Extraction

Baseline and outcome data were independently extracted by two reviewers . The trial design, population characteristics, inclusion and exclusion criteria, surgery type, patient source, regimen of drug administration, and postsurgical wound infection rates were extracted. Disagreements were resolved by a third reviewer .

The primary outcome was the incidence of SSI, presented as the event rate. The secondary outcome was the incidence of contact dermatitis, which represents the safety outcome.

Should Water Or An Antiseptic Be Used To Cleanse A Wound

Antiseptics are commonly used to irrigate contaminated wounds. In studies of clean surgical incisions, there was no high-quality evidence that one antiseptic was superior to another for preventing wound infections. Tap water and sterile saline irrigation of uncomplicated skin lacerations appear to be equally effective. Patients may prefer irrigation with warm fluids.

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Description Of The Condition

Many surgical procedures are conducted each year. The majority of these procedures result in wounds that heal by primary intention, which means that the wound edges are brought together using sutures, staples, clips or glue. Wounds can also heal by secondary intention, then the edges are not approximated and the wound heals by granulation, reepithelialisation and contraction. Most wounds heal without complications but surgical site infections can occur after surgery in the site where the surgery took place. Most wound infections are caused by contamination during surgery with the patients own microorganisms . They may be superficial and selflimiting, involving the skin only, or they may be deeper and lifethreatening. SSIs are classified by the Centers for Disease Control and Prevention as superficial incisional, deep incisional and organ/space infections .

SSIs account for up to 20% of all of healthcareassociated infections . At least 5% of patients who have a surgical procedure will go on to develop an SSI, highlighting the importance of good prevention, detection and management . SSIs can delay healing, impair cosmetic outcomes and potentially cause other morbidity, such as deeper infections, as well as potentially increasing costs, and the consumption of healthcare resources .

How The Intervention Might Work

Table 1 from Topical antibiotics for preventing surgical ...

The role of topical antibiotics is to reduce the microbial contaminant exposure following the surgical procedure. A surgeon may choose to use a topical antibiotic on a wound after considering the likelihood of infection and weighing up the risks and benefits of treatment. There is a lack of evidence in the literature regarding the effects of antibiotic ointment in preventing wound infection.

Topical antibiotics have a number of mechanisms of action. Chloramphenicol is a bacteriostatic broadspectrum antibiotic that exerts an effect by inhibiting protein synthesis of the bacteria and interfering with transfer of activated amino acids to ribosomes. Neomycin has moderate Gramnegative action through inhibition of protein synthesis. Mupirocin is active against Grampositive aerobic bacteria by inhibiting bacterial protein synthesis . Antibiotics differ from antiseptics as they target specific organisms selectively, whereas antiseptics destroy or inhibit the growth of organisms non selectively .

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