What over-the-counter (OTC) topical antibiotic, such as Neosporin (neomycin, polymyxin B, and bacitracin), is recommended for a wound laceration?

Over-the-Counter Topical Antibiotics for Wound Lacerations

Triple antibiotic ointment containing bacitracin, neomycin, and polymyxin B (e.g., Neosporin) is the recommended over-the-counter topical antibiotic for wound lacerations due to its proven efficacy in reducing infection rates and promoting faster healing.

Rationale for Triple Antibiotic Ointment

Triple antibiotic ointment provides several advantages for wound care:

• Significantly lower infection rates (4.5-5.5%) compared to petroleum jelly (17.6%) in uncomplicated soft-tissue wounds 1
• Synergistic antimicrobial activity against common wound pathogens including Staphylococcus aureus and Pseudomonas aeruginosa 2
• Faster healing time (mean 9 days) compared to antiseptics or no treatment 3
• Effective elimination of bacterial contamination after just two applications 3

Application Protocol

1. Clean the wound thoroughly with soap and lukewarm water for at least 20 seconds
2. Apply a thin layer of triple antibiotic ointment to the wound surface
3. Cover with a sterile dressing and change 2-3 times daily
4. Continue application until the wound is healed or for up to 7 days

Evidence-Based Considerations

Efficacy

Triple antibiotic ointment maintains high efficacy against common wound pathogens despite decades of use:

• 95% effective against Staphylococcus aureus
• 100% effective against coagulase-negative staphylococci and Pseudomonas aeruginosa 4
• Maintains activity against mupirocin-resistant strains 4

Safety Considerations

• Contact dermatitis is a potential side effect, particularly with neomycin component
• Avoid application to:
  • Grossly contaminated wounds 5
  • Deep puncture wounds
  • Animal bites requiring rabies prophylaxis 5

Special Populations

For higher-risk wounds, systemic antibiotics may be indicated instead of or in addition to topical antibiotics:

• Immunocompromised patients
• Asplenic individuals
• Patients with advanced liver disease
• Wounds with significant edema
• Moderate to severe injuries, especially to hands or face
• Injuries that may have penetrated periosteum or joint capsule 5

Alternative OTC Options

If allergic to components of triple antibiotic ointment:

• Bacitracin-only ointment - Effective against gram-positive bacteria but with narrower spectrum
• Petroleum jelly - For very minor wounds with low infection risk, though infection rates are higher than with antibiotic ointments 1

Caveats and Pitfalls

• Do not use on grossly contaminated wounds that require thorough debridement
• Do not use as a substitute for proper wound cleaning and irrigation
• Avoid prolonged use beyond 7 days to prevent development of contact dermatitis
• Discontinue if rash or irritation develops
• Seek medical attention for:
  • Deep or gaping wounds that may require sutures
  • Signs of infection (increasing redness, warmth, swelling, purulent drainage)
  • Wounds with foreign bodies or significant contamination

Triple antibiotic ointment remains a cornerstone of over-the-counter wound care due to its proven efficacy, broad antimicrobial spectrum, and excellent safety profile when used appropriately.