Should I apply bacitracin (topical antibiotic ointment) directly over my sutures?

Application of Bacitracin Over Sutures

Bacitracin ointment should not be routinely applied over sutures as it provides no significant benefit for preventing surgical site infections in clean wounds and may cause allergic contact dermatitis. 1, 2

Evidence Against Routine Bacitracin Use

• Topical antibiotics are not routinely indicated for surgical site infections after adequate incision and drainage according to the Infectious Diseases Society of America guidelines 1
• Bacitracin has been identified as a rising allergen with increasing rates of clinically relevant allergic contact dermatitis and rare cases of near-fatal anaphylaxis 2
• The clinical efficacy, scientific evidence, and need for medical cost containment all advocate against routine usage of bacitracin in clean surgical wounds 2
• Topical use of bacitracin may produce treatment failure and sensitization 3

When Topical Antibiotics May Be Considered

• Topical antibiotics may be considered in specific situations:
  • For blepharitis (eyelid inflammation), where bacitracin can be prescribed and applied on the eyelid margins one or more times daily or at bedtime for a few weeks 1
  • For hemodialysis catheter exit sites, where povidone-iodine antiseptic ointment or bacitracin/gramicidin/polymyxin B ointment can be used after catheter insertion and at the end of each dialysis session 1

Alternatives to Bacitracin

• White petrolatum (petroleum jelly) is a safe, effective wound care ointment for post-surgical wounds with an equally low infection rate compared to bacitracin and minimal risk for allergic reactions 4
• For clean surgical wounds, keeping the wound clean and dry is generally sufficient for proper healing 1

Surgical Site Infection Prevention

• The cornerstone of surgical site infection prevention includes:
  • Proper wound cleansing and irrigation during the procedure 1
  • Appropriate suture technique and removal 1
  • Identification and treatment of predisposing factors such as edema, obesity, or other underlying conditions 1

Monitoring for Complications

• Monitor the wound for signs of infection such as increasing pain, redness extending >5 cm from the wound edge, swelling, warmth, purulent drainage, or systemic symptoms like fever 1, 5
• If signs of infection develop, prompt evaluation is necessary, potentially including incision and drainage if an abscess forms 5

Conclusion

Based on the most recent and highest quality evidence, routine application of bacitracin over sutures is unnecessary and potentially harmful due to the risk of allergic reactions. White petrolatum or simply keeping the wound clean and dry is sufficient for most uncomplicated wounds healing by primary intention.