September 4, 2006

Clean surgical wounds don’t need antibiotic cream

NEW YORK (Reuters Health) - An ointment containing the
antibiotic mupirocin does not speed healing or prevent
infection when applied to clean surgical wounds before the
wound is sealed, research suggests. In fact, the ointment may
increase the risk of skin edge necrosis (death), an Australian
research team found.

Mupirocin is effective in treating contaminated lesions and
skin infections, and is widely advocated even when wounds are
not contaminated, although there is little evidence to support
the latter recommendation, according to Dr. Anthony Dixon, a
dermasurgeon and skin cancer specialist from Skincanceronly in

Moreover, there are data indicating a risk of mupirocin
resistance that could reduce its effectiveness over time.

To investigate further, Dixon and colleagues studied 778
patients with a total of 1801 wounds. Following surgical
treatment, 510 wounds were randomly assigned to no ointment,
729 to paraffin ointment, and 562 to mupirocin ointment.
Patients were asked to complete and return surveys 6 months
later to ascertain long-term outcomes.

The investigators observed no significant differences among
the three groups in the number of wound infections, pain or
wound discomfort, long-term cosmetic outcomes or overall

However, Dixon's group found it somewhat alarming that
seven cases of skin necrosis occurred in the mupirocin group,
versus one in the paraffin group and zero in the no-ointment

In a report in the British Journal of Surgery, they
propose, "Existing advice regarding the role of ointments on
wounds (largely antibiotic ointment) following skin lesion
surgery and before dressing should be reviewed in the light of
these findings."

SOURCE: British Journal of Surgery, August 2006.