Proper Wound Cleaning Alone is Sufficient for Simple Abrasions
For uncomplicated superficial abrasions, thorough wound cleaning with tap water or saline and covering with an occlusive dressing is adequate treatment without fusidic acid or any topical antibiotic. 1, 2
When Topical Antibiotics Are NOT Needed
The most recent American Heart Association guidelines (2024) clearly state that clean superficial wounds and abrasions should be thoroughly irrigated until there is no obvious debris or foreign matter, then covered with an occlusive dressing 1. Notably, these guidelines do not recommend routine topical antibiotics for simple abrasions.
Evidence Supporting Cleaning Alone
Occlusive dressings without antibiotics promote wound healing effectively - film, petrolatum, hydrogel, and cellulose/collagen dressings all result in better wound healing than dry dressings, with no indication that antibiotic dressings improve outcomes or decrease infection rates in clean wounds 1
Tap water is as effective as sterile saline for wound irrigation and does not increase infection rates 1, 2
A 2015 retrospective study of 429 clean dermatologic wounds found no significant difference in adverse events between fusidic acid (1.4%) and petrolatum alone (0.5%), with the authors recommending petrolatum over topical antibiotics for clean procedures due to equivalent efficacy and superior safety 3
When Fusidic Acid or Antibiotics ARE Indicated
The guidelines are clear about specific high-risk scenarios requiring antibiotics:
Absolute Indications for Antibiotics (Oral, Not Topical)
Human or animal bite wounds or contamination with saliva - these require immediate medical evaluation and oral antibiotics, not topical treatment 1, 4, 5
Gross contamination with soil or field debris - oral therapeutic antibiotics are indicated 4
Signs of established infection (redness, warmth, swelling, purulence, increasing pain, fever) - oral therapeutic antibiotics are required 4
Important Distinction: Oral vs Topical
When antibiotics are indicated for contaminated or infected wounds, oral antibiotics are preferred over topical antibiotics because they achieve adequate tissue penetration 4. Topical antibiotics like fusidic acid are only appropriate for superficial, clean, or mildly contaminated wounds 4.
The Fusidic Acid Context
While fusidic acid appears in older guidelines for outpatient MRSA skin infections 1, this is for established infections, not prophylaxis of simple abrasions. The evidence shows:
Fusidic acid reduced surgical site infections in cesarean sections 6, but this is a surgical wound context, not a simple abrasion
A Cochrane review found topical antibiotics reduce surgical site infections compared to no antibiotic (RR 0.61), but this applies to surgical wounds healing by primary intention, not simple abrasions 7
Critical Monitoring for Complications
If the patient develops redness, swelling, foul-smelling drainage, increased pain, or fever after initial wound care, they should remove the dressing, inspect the wound, and obtain medical care 1. This is when oral antibiotics would be indicated, not topical fusidic acid.
Common Pitfalls to Avoid
Do not use antibiotics as a substitute for proper wound cleaning - this is the most common error 4
Do not give prophylactic antibiotics to uninfected wounds, even if they appear "dirty" with debris - proper irrigation and debridement is the priority 4
Do not use topical antibiotics when oral antibiotics are indicated - topical agents lack adequate tissue penetration for contaminated or infected wounds 4
Bottom Line Algorithm
For a simple abrasion: