From the Guidelines
I do not recommend using Bactrim DS (trimethoprim-sulfamethoxazole) as prophylaxis following the excision of a sebaceous cyst from the patient's right upper back, as the most recent and highest quality study 1 suggests that antibiotic prophylaxis should only be administered for operative procedures that have a high rate of postoperative surgical site infection (SSI), or when foreign materials are implanted. Since the patient underwent a simple excision of a sebaceous cyst, which is not typically considered a high-risk procedure for SSI, and no foreign materials were implanted, prophylactic antibiotics are not necessary. The patient should be instructed to keep the surgical site clean and dry, changing any dressing as directed, typically once daily or if it becomes soiled. The sutures will need removal in 7-10 days, depending on the healing progress. The patient should be advised to watch for signs of infection (increasing redness, warmth, swelling, purulent drainage, or fever) and to report these promptly if they occur. It is essential to follow proper infection control practices, including hand hygiene and sterile technique, to minimize the risk of infection. According to the study 1, strategies to prevent SSIs should always include attention to infection control practices, meticulous surgical techniques, and minimization of tissue trauma. Additionally, the study 1 states that there is no evidence to support the use of postoperative antibiotic prophylaxis, which further supports the decision not to prescribe Bactrim DS in this case. It is crucial to develop guidelines for proper surgical prophylaxis and to educate healthcare professionals on the appropriate use of antibiotics to prevent unnecessary use and reduce the risk of antibiotic resistance.
From the FDA Drug Label
The recommended dosage for prophylaxis in adults is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet daily
- The patient is an adult, so the recommended dosage for prophylaxis is 1 sulfamethoxazole and trimethoprim DS tablet daily 2.
- Based on the information provided, prescribing Bactrim DS as prophylaxis is appropriate, but the dosage should be 1 tablet daily.
From the Research
Patient Treatment and Antibiotic Prophylaxis
- The patient was diagnosed with a sebaceous cyst, which was removed completely, and the skin was closed with five stitches.
- The decision to prescribe Bactrim DS (trimethoprim-sulfamethoxazole) as prophylaxis was made, but the provided studies do not directly address the use of this antibiotic in this specific context.
- However, the studies do provide information on the effectiveness and safety of trimethoprim-sulfamethoxazole compared to other antibiotics, such as amoxicillin-clavulanate, in various infections 3, 4, 5, 6, 7.
Antibiotic Efficacy and Safety
- A study from 1990 compared the effectiveness of trimethoprim-sulfamethoxazole and amoxicillin-clavulanate in the treatment of acute otitis media, finding that trimethoprim-sulfamethoxazole was more effective and had fewer side effects 3.
- A 2024 case report described the successful use of amoxicillin-clavulanate in the treatment of a pulmonary abscess caused by Tropheryma whipplei infection 4.
- A 2025 systematic review and meta-analysis found that sulfamethoxazole-trimethoprim was associated with a higher risk of adverse drug events, including rash and skin disorders, compared to other antibiotics 5.
- A 2016 study found that trimethoprim-sulfamethoxazole resistance was common in uncomplicated urinary tract infections, and suggested that fosfomycin could be a viable alternative 6.
- A 2009 meta-analysis compared the effectiveness and toxicity of semisynthetic penicillins and trimethoprim-based regimens in treating acute bacterial exacerbations of chronic bronchitis, finding no significant differences between the two 7.