Prophylactic antibiotics in traumatic wounds

Prophylactic Antibiotic Therapy in Contaminated Traumatic Wounds: Two Days versus Five Days Treatment

INTRODUCTION

Emergency department manages several kinds of wounds including simple, non-bite traumatic wounds and lacerations. Prophylactic antibiotic therapy is one of pre-scribed treatment in these conditions. We aimed to compare the clinical efficacy of the two day regimen of prophylactic antimicrobial agents with the five day regimen in simple traumatic but highly contaminated wounds.

METHODS

Between January 2010 and May 2010, patients presenting with simple traumatic wounds or lacerations in different parts of the body, highly contaminated with soil, debris or feces in emergency department of a referral educational hospital in Tehran (Rasul-Akram hospital), Iran, went for primary closure. All of the patients were provided prophylactic antibiotic, however, prescribed for one group (A) of patients for 2 days and other group (B) received for 5 days, according to the physician concerned. As these treatments were routine, we selected 70 patients from each group using table of random numbers. The patients were warned about the signs of infection including long-lasting erythema, purulent discharge and inflammation and were supposed to inform the concerned physician in any of such alarming situations. Oral Cephalexin 500 mg qid was prescribed for all patients enrolled for prophylaxis treatment.

RESULTS

On follow-up 11 (8.2%) patients were found to develop sutured site infection (6 out of 70 (8.57%) in group A, and five out of 70 (7.14%) in group B (P=0.31)). There was no statistical difference between infection rates between men (8.6%) in comparison to women (6.25%) (P>0.05; CI=95%).

CONCLUSION

Our study showed that 2-day prophylactic antibiotic therapy using Cephalexin is at least as effective as a 5-day regimen in relation to development of surgical site infection in patients with simple traumatic contaminated wounds or lacerations.

Wound management

Wound management makes up an important part of the emergency physician's practice. Understanding the physiology of wound healing and the patient and wound factors affecting this process is essential for the proper treatment of wounds. There are many options available for wound closure. Each modality has its benefits and its drawbacks, and some are appropriate only for certain types of wounds. The goal is to achieve the best functional and cosmetically appealing scar while avoiding complications.

Penicillin prophylaxis in complicated wounds of hands and feet: a randomized, double-blind trial

The purpose of the study was to examine the effect of prophylactic penicillin treatment on the infection rate in patients with traumatic wounds of hands or feet with underlying lesions of bone, tendon or joint. A total of 599 patients were randomized to double-blind treatment with either (A) one injection of penicillin G, (B) penicillin V tablets for 6 days or (C) no antibiotic treatment. In group A the infection rate was 4.9 per cent, in group B 6.7 per cent and in group C 10.2 per cent. The difference between the infection rates in group A and C was 5.3 per cent with a 95 per cent confidence interval (CI) from 0.1 to 10.4 per cent (P = 0.046). Correction for an interim analysis and subgroup analyses increases this P value to 0.096. The difference between the infection rates in group B and C was 3.6 per cent (95 per cent CI from -1.9 to 8.9, P = 0.20). Patients in group B had gastrointestinal complaints five times as often as patients in group A and C. Prophylactic tablets for 6 days require patients' co-operation while an injection ensures that the prophylaxis is given. We therefore conclude that a single prophylactic injection of two million units of penicillin G is advisable for patients with these injuries.

Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies

A meta-analysis was conducted to determine whether prophylactic systemic antibiotics prevent infection in patients with nonbite wounds that are managed in the emergency department (ED). A literature search was performed to identify published, randomized trials of prophylactic antibiotics for nonbite wounds. Blinded review of trial methods was used to select trials that randomly assigned patients to antibiotic or control groups and analyzed results by intention to treat. Of 9 randomized trials, 7 (with 1,734 study subjects) were accepted for analysis. The odds ratio for infection in treated patients compared with controls was used as the measure of effect, and a summary odds ratio was calculated. Patients treated with antibiotics had a slightly greater incidence of infection compared with untreated controls: odds ratio 1.16 (95% confidence interval [CI] 0.77 to 1.78). Even among patients treated with a penicillinase-resistant antibiotic (5 trials with 1,204 patients), there was no benefit from treatment; odds ratio 1.00 (95% CI 0.59 to 1.71). In conclusion, there is no evidence in published trials that prophylactic antibiotics offer protection against infection of nonbite wounds in patients treated in EDs.