From the Guidelines
I strongly advise against prescribing Bactrim DS as prophylaxis after the surgical removal of the sebaceous cyst, as there is no evidence to support the use of postoperative antibiotic prophylaxis. I performed a surgical procedure on a 36-year-old male inmate to remove what was initially thought to be a lipoma on his right upper back. Upon incision, I discovered it was actually a sebaceous cyst, which I completely excised. I closed the wound with five sutures.
Key Considerations
- The guidelines recommend that antibiotic prophylaxis should be used to prevent infections before and during surgery only, and not after surgery 1.
- There is no evidence to support the use of postoperative antibiotic prophylaxis, and this practice may contribute to antibiotic resistance and other adverse effects 1.
- The patient should keep the wound clean and dry, and sutures will likely need removal in 7-10 days depending on healing progress.
Post-Operative Care
- Monitor the patient for signs of infection, such as redness, swelling, or increased pain at the surgical site.
- Provide instructions on proper wound care and follow-up appointments to ensure timely suture removal and assessment of wound healing.
- Consider the patient's overall health and any underlying conditions that may affect wound healing or increase the risk of infection.
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 Bactrim DS tablet daily.
- Based on the information provided, prescribing Bactrim DS as prophylaxis for the patient is appropriate, given the dosage is 1 tablet daily 2.
From the Research
Antibiotic Prophylaxis for Skin Infections
- The use of trimethoprim/sulfamethoxazole (TMP-SMX) as antibiotic prophylaxis for skin infections has been studied in various contexts 3, 4, 5.
- A study on vascular surgery found that changing the prophylactic antibiotic therapy from cloxacillin to TMP-SMX did not improve the surgical site infection rate 3.
- Another study on elective colorectal surgery found that orally administered TMP-SMX resulted in a low rate of organ/space surgical site infections but an increased rate of incisional surgical site infections compared to intravenously administered cefuroxime and metronidazole 4.
- A study on lower extremity revascularization found that changing the antibiotic prophylaxis from cloxacillin/cefotaxime to TMP-SMX increased the inguinal surgical site infection rate 5.
Effectiveness of TMP-SMX Prophylaxis
- TMP-SMX has been shown to be effective in preventing certain infections, such as Pneumocystis carinii pneumonia, toxoplasmosis, and salmonellosis, in HIV-infected patients 6.
- However, a study on children with vesicoureteral reflux found that daily prophylaxis with TMP-SMX was not associated with an increased or decreased risk of skin and soft tissue infections, pharyngitis, or sinopulmonary infections 7.
Considerations for Prophylaxis
- The choice of antibiotic prophylaxis may have a limited role in preventing surgical site infections, and other factors such as patient characteristics and surgical procedure may be more important 3.
- The use of TMP-SMX as prophylaxis may be associated with an increased risk of certain infections, such as inguinal surgical site infections, in certain contexts 5.
- The decision to use TMP-SMX as prophylaxis should be based on individual patient factors and the specific surgical procedure being performed 4, 5.