What antibiotics are used to treat wounds?

Antibiotic Selection for Wound Treatment

For most wound infections, first-line antibiotic therapy should include amoxicillin-clavulanic acid or cloxacillin for empiric coverage of common skin pathogens, while specific wound types require targeted antibiotic therapy based on likely pathogens. 1

Antibiotic Selection by Wound Type

Mild to Moderate Skin and Soft Tissue Infections

• First-choice antibiotics include amoxicillin-clavulanic acid or cloxacillin for empiric coverage of common skin pathogens including Staphylococcus aureus and streptococci 1, 2
• For suspected or confirmed MRSA infections, consider sulfamethoxazole-trimethoprim 1, 3
• For purulent skin infections, primary treatment is incision and drainage; antibiotics are adjunctive, with options including dicloxacillin, cefalexin, clindamycin, doxycycline, and sulfamethoxazole-trimethoprim 1

Open Fractures

• For Gustilo-Anderson type I and II open fractures, first- or second-generation cephalosporins (e.g., cefazolin) are recommended 1, 4
• For Gustilo-Anderson type III open fractures, combine a first- or second-generation cephalosporin with an aminoglycoside for enhanced gram-negative coverage 4
• Antibiotics should be started as soon as possible after injury, with a significant increase in infection risk if delayed beyond 3 hours 4

Animal and Human Bites

• Amoxicillin-clavulanic acid or ampicillin-sulbactam are recommended for both animal and human bites 1, 5
• Human bites can transmit HBV, HCV, and HIV, so post-exposure prophylaxis should be considered 5

Diabetic Wound Infections

• First-line options for mild infections include dicloxacillin, clindamycin, cefalexin, levofloxacin, amoxicillin-clavulanic acid, or doxycycline 1, 5
• For moderate to severe diabetic foot infections, broader spectrum coverage may be needed 5

Burn Wounds

• Systemic antibiotic prophylaxis administered in burn patients in the first 4–14 days significantly reduced all-cause mortality 5
• Topical antibiotic prophylaxis applied to burn wounds showed no beneficial effects compared to dressings/skin substitutes 5
• Silver sulfadiazine was associated with increased burn wound infection compared with dressings/skin substitutes 5

Topical vs. Systemic Antibiotics

Topical Antibiotics

• Topical antibiotics (bacitracin, neomycin, polymyxin B combinations) have been shown to significantly reduce infection rates in uncomplicated wounds compared to petrolatum 6
• Advantages include higher concentration at the target site, fewer systemic adverse effects, and potentially lower incidence of antimicrobial resistance 7
• However, topical antibiotics may cause contact dermatitis and contribute to the development of resistant organisms with prolonged use 7

Systemic Antibiotics

• For deep or complex wounds, systemic antibiotics are preferred over topical agents 5
• For open fractures, systemic antibiotics are essential and should be administered within 3 hours of injury 4
• Duration of therapy for open fractures: 3 days for type I/II and 5 days for type III 4

Special Considerations

Local Antibiotic Delivery Systems

• Local antibiotic delivery systems (such as antibiotic-impregnated beads) may be beneficial as adjuncts in severe cases, particularly for open fractures with bone loss 4
• Gentamicin-coated implants have been demonstrated to be safe in clinical application for traumatic fractures 5

Timing of Administration

• For open fractures, antibiotics should be started as soon as possible, with significant increase in infection risk if delayed beyond 3 hours 4
• For surgical prophylaxis, antibiotics should be administered within 60 minutes before incision 1

Common Pitfalls to Avoid

• Delaying antibiotic administration beyond 3 hours post-injury for open fractures significantly increases infection risk 4
• Failing to obtain cultures before starting antibiotics in complex or severe infections 1
• Continuing antibiotics beyond recommended duration without evidence of ongoing infection 4
• Using silver sulfadiazine for burn wounds may increase infection rates compared to modern dressings 5
• Relying solely on antibiotics without adequate debridement and wound care 5