From the Guidelines
Antibiotic prophylaxis is not necessary for a laceration.
Rationale
- The evidence suggests that antibiotic prophylaxis is not recommended for simple lacerations or small soft tissue trauma 1.
- The updated Surgical Infection Society guidelines recommend against administration of extended-spectrum antibiotic coverage compared with gram-positive coverage alone to decrease infections complications, hospital length of stay or mortality in type I or II open extremity fractures 1.
- A study found that there is no conclusive evidence supporting prophylactic antimicrobial use in the management of small soft tissue upper extremity trauma and simple lacerations 1.
- The 2018 WSES/SIS-E consensus conference recommends 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 for lacerations, and universal prophylaxis with antibiotics is not recommended 1.
Exceptions
- However, early antibiotic treatment for 3 to 5 days may be recommended for fresh, deep wounds and wounds in certain critical bodily areas (hands, feet, areas near joints, face, genitals), for persons at elevated risk of infection, and for persons with implants, such as artificial heart valves 1.
- Bite wounds on the hands may also require prophylactic antibiotics 1.
From the Research
Antibiotic Prophylaxis for Lacerations
- The necessity of antibiotic prophylaxis for lacerations is a topic of debate, with varying opinions depending on the location and severity of the wound 2, 3.
- Studies have shown that routine antibiotic prophylaxis may not be necessary for simple lacerations, such as those on the hand or intraoral lacerations, as the infection rate is relatively low 3, 4.
- However, some studies suggest that antibiotic prophylaxis may be beneficial for larger or more complex wounds, such as those requiring suturing or with a higher risk of contamination 2, 5.
- A randomized controlled trial found that the infection rate for simple hand lacerations was low, regardless of whether antibiotic prophylaxis was used, and that a large sample size would be needed to determine the effectiveness of antibiotic prophylaxis in this context 6.
- The decision to use antibiotic prophylaxis for lacerations should be based on individual patient factors, such as the severity of the wound and the risk of contamination, rather than routine use 2, 3.
- Further research is needed to determine the optimal use of antibiotic prophylaxis for lacerations, particularly in cases where the risk of infection is higher 4, 5.