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Primer: Uncomplicated soft tissue injuries are one of the most common ailments treated in the emergency department. However, there has been little agreement regarding the proper management of these minor wounds, particularly with regards to use of topical antibiotics. To gather evidence supporting a standard of care for the management of uncomplicated and minor soft tissue trauma, the authors of this study aimed to review the published literature on this topic
This review: Four databases were searched for publications featuring randomized controlled trials (RCT) that addressed the prevention minor wound infections via the use of topical antibiotics. Of 200 search results, only four articles met inclusion criteria. We have summarized the key points in each article below:
– Dire et al., 1995: A prospective RCT that compared infection outcomes for minor soft tissue wounds treated with antibiotic-free carrier ointment versus those treated with 1 of 3 antibiotic ointments. The authors found a significant difference between infections rates for the control group versus those treated with topical antibiotics (p=0.002), but no difference between the 3 different antibiotic ointments (p=0.14).
– Hood et al., 2004: A prospective randomized trial that compared infection rates in soft tissue injuries treated with triple antibiotic versus those treated with mupirocin. The authors found that those treated with muprocin had higher infection rates (4%) compared to those given triple antibiotic (0%).
– Langford et al., 1997: A prospective RCT that compared infection rates for minor wounds in the pediatric population treated with either a novel antibiotic combination (cetrimide, bacitracin, and polymyxin B), iodine antiseptic or placebo gel. The authors found a significant difference in infection rates between those treated with the novel antibiotic combination versus those given the control gel (P<0.05, CI: 0.011-0.207)
– Maddox et al., 1985: This blinded prospective study compared the efficacy of triple antibiotic to placebo ointment in the prevention of streptococcal skin infections in children. The authors found that while 47% of the placebo group developed lesions, only 15% of the triple antibiotic group suffered streptococcal infections.
In sum: From their review of the published research, the authors of this study concluded that “topical antibiotics do reduce the infection rate of acute, minor, uncomplicated soft tissue wounds.” The article does note that the available data is insufficient for analysis in a formal systematic literature review or meta-analysis format. However, this peer-reviewed study aims to present the “best available evidence” supporting the use of topical antibiotics in the standard of care for the treatment of uncomplicated soft tissue wounds.
Click to read the article in Annals of Emergency Medicine (in press, online only)
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