A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections

Abstract

BackgroundThe prescription of topical antibiotics for the prevention of infections in uncomplicated wounds is common. However, the efficacy is not well reported. Therefore, the objective of the study was to conduct a systematic review and meta-analysis of the available evidence on prevention of uncomplicated wound infections by prophylactic topical antibiotics.Materials and methodsThe search included Pubmed, Google Scholar, SCOPUS, Embase, Cochrane, ClinicalTrials.gov, International Clinical Trials Registry Platform, National Technical Information Service, and the National Guidelines Clearinghouse.ResultsWe identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematic review. Of these trials, 11 studies were pooled for meta-analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk difference: −3.1% [95% CI: −5.8% to −0.34%]; p=0.03). Compared to antiseptics, topical antibiotics demonstrated statistically significant relative risk reduction (pooled risk ratio: 0.56 [95% CI: 0.23 to 0.91]; p=0.02), while there was no significant absolute risk reduction (pooled risk difference: −3.7% [95% CI: −7.9% to +0.6%]; p=0.09).ConclusionTopical antibiotics are effective in reducing wound infections after surgical procedures, but the absolute benefit is small. Given the global emergence of antimicrobial resistance, judicious use of antibiotics is encouraged and use of antiseptics should be considered as a reasonable alternative to topical antibiotics.

Non-invasive nanosecond electroporation for biocontrol of surface infections: an in vivo study

“…The management of an infection in thermal injury presents challenges in terms of clinical diagnosis and rapid definition of effective antimicrobial therapy 4 , 5 . Topical antibiotics are effective in reducing such wound infections, however the absolute and long-term benefit is small 6 since the accelerated evolution of bacterial resistance is frequently associated with a widespread use of antibiotics 7 , 8 . Therefore, with the emergence of multidrug-resistant strains, alternative strategies to control or prevent infections must be developed in parallel with novel antimicrobial agents 9 – 11 .…”

Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis

“…Similar findings were reported in the study by Tong et al . 11 , where topical antibiotics were found to reduce the risk of SSI versus antiseptics or placebo (RR 0.56 (95 per cent c.i. 0.34 to 0.91) and RR 0.57 (95 per cent c.i.…”

“…Postoperatively, topical antibiotics are an option with several advantages, including a high drug concentration at the application site, a low incidence of systemic side effects, and good patient compliance 11 . Nevertheless, there is still controversy over their use owing to possible detrimental effects, such as local allergic reactions, poor skin penetration, and the emergence of resistant organisms with antibiotic exposure 11 .…”

“…Postoperatively, topical antibiotics are an option with several advantages, including a high drug concentration at the application site, a low incidence of systemic side effects, and good patient compliance 11 . Nevertheless, there is still controversy over their use owing to possible detrimental effects, such as local allergic reactions, poor skin penetration, and the emergence of resistant organisms with antibiotic exposure 11 . The Centers for Disease Control and Prevention 2017 guideline for the prevention of SSI states that additional prophylactic antibiotics should not be administered after the closure of the surgical incision in clean and clean-contaminated procedures 3 .…”

Nano-in-Micro Dual Delivery Platform for Chronic Wound Healing Applications

“…Bacterial infection is considered a major problem in chronic wounds as it can delay healing and cause patient morbidity [13]. Topical or systematic administration of antibiotics can manage the infection, but they may cause allergic reactions and/or antibiotic resistance without significant contribution to the healing process [14,15]. Utilizing sustained and localized delivery methods can improve the therapeutic outcome [16,17].…”