University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Do systemic antibiotics prevent infection of simple wounds sutured in the ER?

Clinical Bottom Lines

1. Systemic antibiotics offer no benefit in preventing infection of simple wounds sutured in the E.R. setting.¹
2. Certain immunocompromised populations may benefit from systemic antibiotics, such as diabetic patients, AIDS patients, chemotherapy patients or those on chronic steroids. Additional studies are needed in these populations.
3. Systemic antibiotics are indicated in human and animal bite wounds.²

Summary of Key Evidence

1. This article is a meta-analysis of 7 randomized studies (from 1975-83) comparing systemic antibiotics to control groups for non-bite wounds. Searched Medline using "wound infection" and "antibiotics." There is no description of what criteria were used to assess each article's validity.
2. There were problems with several of the articles (no blinding in 3/7, 5/7 included sutured wounds, 5/7 were hand wounds, antibiotics were different and given by different routes). Despite these variations, all combinations of studies produced odds ratios around 1.
3. A summary odds ratio of 1.16 was calculated for all seven studies, indicating that there was no protective benefit of antibiotics in preventing infection.¹
4. The outcome of infection was not affected by the type of antibiotic used, by the route administered or by the duration of treatment.

Additional Comments

• Decreased rates of wound infection reported in sutured lacerations treated with topical Neosporin or Bacitracin TID until suture removal.³
• Well-vascularized areas of the body such as the scalp and face are less likely to become infected.²
• Consequences of wound infections may include the need for IV antibiotics and cosmetically less-appealing scars.

Citation

1. Cummings P, Del Beccaro MA. Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies. Am J Emerg Med 1995; 13:396-400.
2. Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. NEJM 1997; 337 (16):1142-8.
3. Dire DJ, Coppola M, Dwyer DA, Lorette JL, Karr JL. Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED. Acad Emerg Med 1995; 2:4-10.

CAT Author: Jennifer J. King, MD

CAT Appraisers: John G. Frohna, MD

Date appraised: May 14, 2001