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Abstract
A short cut review was carried out to establish whether topical antibiotics improved the outcome of simple wounds. Altogether 71 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.
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Report by A Van Zyl, D Abbott, D Andrews, P ReavesSenior House Officers Checked by Hamish Simpson, Consultant
Clinical scenario
A 26 year old man attends the emergency department with a simple laceration requiring suturing. You wonder whether application of a topical antibiotic ointment will promote healing and reduce incidence of infection.
Three part question
In [adults with non-contaminated lacerations] does [the application of topical antibiotics] reduce [the incidence of secondary infection, the length of time dressings are required and achieve a better cosmetic result]?
Search strategy
Medline 1966–07/02 using the OVID interface. [{(exp administration, topical OR topical therapy.mp ) AND (exp antibiotics OR antibiotic$.mp) OR “topical antibiotic$”.mp} AND (exp ointments OR ointments.mp)] AND [exp Staphylococcal infections OR exp Skin OR superficial wound$.mp OR exp Wound healing OR exp Wound infection OR exp” Wounds and Injuries”] LIMIT to human AND English.
Search outcome
Altogether 71 papers were found of which 70 were irrelevant or of insufficient quality for inclusion. The remaining paper is shown in table 7.
Comment(s)
Although this study suggests that antibiotic ointment reduces incidence of infection there are a number of reasons at the moment why we would be reluctant to change current clinical practice. The intensive wound care used in the study may not mirror our own practice. Long term results and patients own assessment of outcome may be better indicators of the benefit of topical antibiotics, than the short-term effects measured in this trial.
▸ CLINICAL BOTTOM LINE
There is not enough evidence here to change current practice. A large multicentre study is indicated to provide more relevant answers.
Report by A Van Zyl, D Abbott, D Andrews, P ReavesSenior House Officers Checked by Hamish Simpson, Consultant