A systematic review and meta-analysis on the use of prophylactic topical antibiotics for the prevention of uncomplicated wound infections

Figures & data

Figure 1 Literature search flow chart.

Table 1 Characteristics of the 12 studies included in the systematic review

Data source/ study location	Type of trial - QRT or RCT	Study methodology and sample size	Interventions	Wound infection rates	Authors’ conclusion
Campbell et al^11/ USA	QRT	Prospective, nonblinded, randomized trial 140 patients 147 wounds	Self-application by subjects:1.Gentamicinointment 2.Petrolatum	Postop suppurative chondritis 1.4/84=4.76% 2.4/60=6.67%	No difference between the use of gentamicin ointment and petrolatum in preventing postoperative auricular suppurative chondritis
Dire et al^12/USA	RCT	Prospective, randomized, doubleblinded, placebocontrolled trial 465 patients 465 wounds	1.Bacitracin 2.BPN 3.Silver sulfadiazine 4.Petrolatum	1.6/109=5.5% 2.5/110=4.5% 3.12/99=12.1% 4.19/108=17.6%	Use of topical antibiotics resulted in significantly lower infection rates
Dixon et al^13/ Australia	RCT	Prospective, blinded, RCT778 patients 1801 wounds	1.Mupirocin 2.Paraffin 3.No ointment prior to placement of moist occlusive dressings	1.13/562=2.3% 2.12/729=1.6% 3.7/510=1.4%	Applying ointment on a surgical wound before occlusive dressing does not benefit the patients
Draelos et al^14/ USA	RCT	Double-blinded, multicenter trial 30 patients 60 wounds	1.Non-antibiotic aquaphor healing ointment 2.Polymyxin/ bacitracin ointment	No wound infection noticed for both groups	No differences were seen between the two groups in stinging, itching, tightness, tingling, or pain. One case of contact dermatitis was noticed in the polymixin/bacitracin group
Heal et al^15/ Australia	RCT	Prospective, randomized, placebocontrolled, doubleblinded, multicenter trial 972 patients 972 wounds	1.Chloramphenicol ointment 2.Paraffin ointment	1.32/488=6.6% 2.53/484=11%	The incidence of infection in the chloramphenicol group was significantly lower than the control group
Kamath et al^16/UK	RCT	Randomized controlled, blinded trial 92 patients	1.Topical 1% chloramphenicol ointment 2.No chloramphenicol ointment	1.4/47=8.5% 2.8/45=17.8%	The risk of developing wound infection was not significant with and without the use of chloramphenicol ointment
Khalighi et al^17/ USA	QRT	Randomized, placebocontrolled trial 1008 patients	1.Providone iodine ointment 2.Neomycin ointment 3.Sterile non-adherent pads 4.Non-antibiotic, nonantiseptic “placebo” (standard dressing)	1.4/257=1.5% 2.2/263=0.7% 3.4/240=1.6% 4.4/248=1.6%	The use of topical antibiotics after closure has not shown significant benefit
Langford et al^18/ Australia	QRT	Randomized, doubleblinded, prospective trial 107 patients 177 wounds	1.CBP 2.PIC 3.Placebo gel	Clinical infection 1. 1/62=1.6% 2.2/67=3% 3.6/48=12.5% Micrologic infection 1.4/48=1.6% 2.2/67=3% 4.4/48=8.5%	CBP reduced the incidence of clinical infections
Maddox et al^19/ USA	RCT	Prospective, doubleblinded trial 59 patientsNumber of wounds not mentioned	1.BPN 2.Placebo	1.4/27=15% 2.15/32=47%	Topical antibiotics may be useful in preventing streptococcal pyoderma
Pradhan and Agrawal^20/Nepal	QRT	Open-label randomized trial70 female patients Number of wounds not mentioned	1.Topical fusidic acid after absorbable subcuticular stitches 2.Povidone-iodine dressing	1.1/35=2.8% 2.6/35=17.1%	The use of fusidic acid reduced the infection rate by six times
Smack et al^21/USA	RCT	Prospective, randomized, doubleblinded trial 884 patients 1207 wounds	1.Bacitracin ointment 2.WP prior to occlusive wound dressings	1.4/444=0.9% 2.9/440=2.0%	WP is a safe and equally effective wound care ointment for surgical wound prophylaxis compared to bacitracin
Taylor et al^22/USA	RCT	Double-blinded, split- face study 20 patients 40 wounds	1.Aquaphor healing ointment 2.Polymyxin B+bacitracin	No infection occurred during thestudy	Antibiotics are not necessary for effective healing of facial wounds

Abbreviations: BPN, bacitracin +polymyxin +neomycin; CBP, cetrimide +bacitracin +polymyxin; PIC, povidone-iodine cream; QRT, quasi-randomized trial; RCT, randomized controlled trial; WP, white petrolatum.

Figure 2 Forest plot showing the risk ratio of topical antibiotics versus placebo on uncomplicated wounds.

Abbreviations: Abx, antibiotics; df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 3 Forest plot showing the risk difference of topical antibiotics versus placebo on uncomplicated wounds.

Abbreviations: Abx, antibiotics; df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 4 Forest plot showing the risk ratio of topical antibiotics versus antiseptic on uncomplicated wounds.

Abbreviations: df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 5 Forest plot showing the risk difference of topical antibiotics versus antiseptic on uncomplicated wounds.

Abbreviations: df, degrees of freedom; M–H, Mantel–Haenszel.

Figure 6 Summarized results by the type of antimicrobial agents used.

Abbreviation: M–H, Mantel–Haenszel.