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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.
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).
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.