From the Guidelines
Antibiotics are not routinely prescribed after a patient receives stitches, but when necessary, the choice of antibiotic should be based on individual risk factors and wound characteristics, with options including cephalexin, dicloxacillin, or clindamycin, as recommended by the Infectious Diseases Society of America 1. Most clean wounds that are properly cleaned, closed, and cared for do not require prophylactic antibiotics. However, antibiotics may be prescribed in specific situations such as contaminated wounds, animal or human bites, wounds with significant tissue damage, or in patients with compromised immune systems. When antibiotics are deemed necessary, common choices include:
- cephalexin (Keflex) 500 mg orally four times daily for 5-7 days
- dicloxacillin 500 mg orally four times daily for 5-7 days
- clindamycin 300-450 mg orally three times daily for 5-7 days, for patients with penicillin allergies The decision to prescribe antibiotics should be based on individual risk factors and wound characteristics, such as the type of wound, the presence of signs of infection, and the patient's overall health status, as outlined in the guidelines for the diagnosis and management of skin and soft tissue infections 1. Proper wound care, including keeping the area clean and dry, watching for signs of infection (increasing redness, warmth, swelling, pus, or fever), and returning for suture removal as directed, is more important than antibiotics for preventing infection in most cases. It is also important to note that cultures from abscesses and other purulent skin and soft tissue infections are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak, as recommended by the Infectious Diseases Society of America 1.
From the Research
Antibiotic Prescription After Receiving Stitches
- The decision to prescribe antibiotics after a patient receives stitches depends on various factors, including the type and severity of the wound, as well as the patient's overall health status 2.
- There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds, and their use is not generally recommended 2, 3.
- However, in cases where the wound is at high risk of infection, such as in patients with compromised immune systems or in wounds that are contaminated with dirt or bacteria, antibiotics may be prescribed 2.
- The choice of antibiotic will depend on the specific circumstances of the wound and the patient's medical history, but common options include oral antibiotics such as cephalexin or topical agents for superficial infections 2.
- It's also important to note that tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years 2.
Wound Infection Prevention and Management
- Preventing wound infection is crucial to promote healing and reduce the risk of complications, and this can be achieved through proper wound care and hygiene practices 4, 5.
- Identifying and managing wound infection early is also important, and this may involve the use of topical or systemic antibiotics, as well as other treatments such as debridement or wound dressings 4, 5.
- The development of antimicrobial sutures is also an area of research that aims to reduce the risk of surgical site infections, which can occur when bacteria colonize the suture surface and establish biofilms that are resistant to antibiotic treatment 6.