Are antibiotics prescribed after wound suturing?

From the Guidelines

Antibiotics are generally not routinely recommended after wound suturing for most clean, uncomplicated wounds. For typical lacerations that have been properly cleaned, irrigated, and sutured within 6-8 hours of injury, the infection risk is low (1-2%), and prophylactic antibiotics provide minimal benefit while increasing the risk of side effects and antibiotic resistance 1. However, antibiotics should be prescribed for high-risk wounds including:

• deep puncture wounds
• contaminated wounds (soil, feces)
• wounds with crushed tissue
• bites (especially human and cat)
• wounds over joints or tendons
• wounds in immunocompromised patients
• and wounds on the hands or feet. When antibiotics are indicated, common regimens include amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) or, for penicillin-allergic patients, doxycycline (100 mg twice daily for 5-7 days) or trimethoprim-sulfamethoxazole plus clindamycin 1. For animal bites, amoxicillin-clavulanate is preferred due to its coverage of Pasteurella species. Regardless of antibiotic use, proper wound care including thorough cleaning, debridement of devitalized tissue, and appropriate follow-up are essential components of preventing infection. Patients should be instructed to keep the wound clean and dry, watch for signs of infection (increasing redness, warmth, swelling, pain, or drainage), and seek medical attention if these develop.

The use of perioperative and postoperative systemic antibiotics for open fractures is recommended, using cefazolin or clindamycin for all types and adding gram-negative coverage with an aminoglycoside for Gustilo/Anderson Type III (and possibly Type II) open fractures 1. The duration of antibiotic therapy should be limited to 24 hours for most surgical procedures, and antibiotics should not be used after surgery unless there is a high risk of infection or foreign materials are implanted 1.

In summary, the decision to use antibiotics after wound suturing should be based on the individual patient's risk factors and the type of wound, and antibiotics should be used judiciously to minimize the risk of side effects and antibiotic resistance. The most recent and highest quality study recommends that antibiotics should be used to prevent infections before and during surgery only, and not after surgery 1.

From the FDA Drug Label

To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. For lengthy operative procedures (e.g., 2 hours or more), 500 mg to 1 gram IV or IM during surgery (administration modified depending on the duration of the operative procedure). 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively

Antibiotic administration after wound suturing is recommended as follows:

• 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively 2 Key points:
• The antibiotic should be administered at appropriate intervals during surgery to provide sufficient levels of the antibiotic at the anticipated moments of greatest exposure to infective organisms.
• The prophylactic administration of cefazolin may be continued for 3 to 5 days following the completion of surgery in certain cases, such as open-heart surgery and prosthetic arthroplasty.

From the Research

Antibiotics After Wound Suturing

• The use of antibiotics after wound suturing is a common practice to prevent infection, but the decision to administer antibiotics depends on various factors, including the type of wound, the patient's overall health, and the presence of any allergies 3.
• According to the American Family Physician, prophylactic antibiotics are not recommended for most simple wounds, but may be indicated for certain patients and clean procedures that fulfill specific risk criteria 3, 4.
• The timing of antibiotic administration is critical to efficacy, with the first dose given before the procedure, preferably within 30 minutes before incision, and readministration at one to two half-lives of the antibiotic for the duration of the procedure 3.
• Postoperative administration of antibiotics is not generally recommended, unless there are specific indications, such as a high-risk patient or a contaminated wound 3, 4.
• Cefazolin is commonly used as a prophylactic antibiotic for surgical procedures, including wound suturing, due to its broad-spectrum activity and relatively low cost 3, 5.
• However, in patients with a penicillin or cephalosporin allergy, alternative antibiotics such as clindamycin may be used, although the risk of surgical site infections may be higher 6.
• The use of topical antibiotics may be beneficial for simple, uncomplicated wounds, and can help reduce the risk of infection and promote healing 7, 4.
• It is essential to note that antibiotics are not a substitute for good local wound care, including irrigation and surgical débridement, and that the judicious use of antibiotics can help reduce unnecessary adverse events and the development of resistance 7, 4.