Is amoxicillin (amoxicillin) indicated for prophylaxis in patients with stitches (sutures)?

From the Guidelines

Amoxicillin is not routinely indicated for prophylaxis in patients with sutures or stitches. Prophylactic antibiotics are generally unnecessary for clean, uncomplicated wounds that have been properly cleaned and closed with sutures. Most sutured wounds heal well without antibiotic prophylaxis when appropriate wound care is provided, including thorough cleaning and proper closure. According to the most recent guidelines, such as those outlined in the 2023 study 1, antibiotic prophylaxis should be used to prevent infections before and during surgery only, and not after surgery.

Key Considerations

• Antibiotics should be reserved for specific situations such as heavily contaminated wounds, bites, wounds with established infection, or in immunocompromised patients.
• For these cases, if antibiotics are deemed necessary, amoxicillin-clavulanate would typically be preferred over amoxicillin alone due to its broader spectrum of activity against skin flora and potential contaminants, as suggested by studies like the 2014 update by the Infectious Diseases Society of America 1.
• The unnecessary use of antibiotics for clean wounds can contribute to antibiotic resistance, disrupt normal flora, and expose patients to potential side effects without providing meaningful benefit.
• Instead of prophylactic antibiotics, proper wound care including keeping the area clean and dry, watching for signs of infection (increasing redness, warmth, swelling, purulent drainage, or fever), and returning for suture removal as directed are the most important aspects of care for most sutured wounds.

Recommendations Based on Evidence

• The 2018 WSES/SIS-E consensus conference recommendations 1 emphasize the importance of using antibiotic prophylaxis before and during surgery for high-risk procedures but do not support its use for routine sutured wounds.
• The 2023 AAOS clinical practice guideline summary 1 recommends antibiotic prophylaxis with systemic cefazolin or clindamycin for patients with major extremity trauma undergoing surgery, highlighting the need for targeted antibiotic use based on the type of injury and surgical procedure.

From the Research

Amoxicillin for Stitches

• Amoxicillin is sometimes used as prophylaxis in patients with stitches (sutures) to prevent wound infections, particularly in clean-contaminated surgery 2.
• The use of amoxicillin-clavulanate as perioperative prophylaxis for 24 hours in clean-contaminated abdominal surgery has been shown to be effective and safe 2.
• However, the decision to use antibiotics, including amoxicillin, for wound prophylaxis depends on various factors, such as the type of surgery, wound complexity, and patient's tetanus status 3.

Specific Studies

• A randomized, controlled trial found that amoxycillin-clavulanic acid (Augmentin) was effective in preventing wound infections in patients with chronic renal failure undergoing major surgery, including transplantation 4.
• Another study reported the successful use of amoxicillin-clavulanate acid in a patient with severe wound infection with wound communication secondary to Actinomyces 5.

General Guidance

• The use of antibiotics, including amoxicillin, for surgical wounds healing by secondary intention is not well established, and the evidence is limited and of low quality 6.
• Current research suggests that antiseptic or antibiotic treatments may be used to prevent or treat infections in open wounds, but the effectiveness of these treatments is not well established 6.