Several controlled trials have demonstrated no benefit
from topical antimicrobials in reducing the frequency of infections in clean
dermatologic surgery. To assess the continued use of prophylactic topical
antibiotics in such procedures, the authors of this study scrutinized
information from the National Ambulatory Medical Care Survey, an ongoing
collection of data from primary outpatient care givers, both general clinicians
and specialists.
The frequency of such use between 1993 and 2007 was 5%
overall, but ranged from 7% among ophthalmologists to 1% among general
surgeons. Among dermatologists, the frequency was 6%, and the most common
procedures were excisions and biopsies. Over the course of the study, however,
dermatologists and plastic surgeons significantly decreased their use of
prophylactic topical antibiotics.
Comment: The use of topical antimicrobials has several
adverse
consequences:
1. They are more expensive than petrolatum, which keeps
the wound appropriately moist.
2. Neomycin and bacitracin often produce allergic contact
dermatitis.
3. Bacitracin occasionally causes anaphylaxis.
4. Widespread use of mupirocin can promote antimicrobial
resistance.
In addition, the infections that do develop are often
from organisms that are resistant to many systemic antimicrobials and are thus
expensive to treat. Accordingly, dermatologists should completely abandon the
use of topical antibiotics for clean procedures.
-- Jan V. Hirschmann, MD
Published in Journal Watch Dermatology September 9, 2011
Citation(s):
Levender MM et al. Use of topical antibiotics as
prophylaxis in clean dermatologic procedures. J Am Acad Dermatol 2011 Aug 8;
[e-pub ahead of print]. (http://dx.doi.org/10.1016/j.jaad.2011.02.005).
