Is antibiotic prophylaxis required after tissue gluing?

Antibiotic Prophylaxis After Tissue Gluing

Routine antibiotic prophylaxis is not required after tissue gluing for clean wounds. The evidence consistently demonstrates that topical antibiotics provide no significant benefit for preventing surgical site infections in clean wounds and may actually cause allergic contact dermatitis 1.

Key Recommendations

Clean Wounds (No Infection Present)

• No antibiotics are needed after tissue gluing for clean, simple wounds 1
• Keeping the wound clean and dry is sufficient for proper healing 1
• Topical antibiotics like bacitracin should not be routinely applied over tissue adhesive closures as they provide no significant benefit and may cause allergic reactions 1

When Antibiotics ARE Indicated

Antibiotics are only warranted in specific circumstances:

• Contaminated or infected wounds (Class III/IV): These require therapeutic antibiotics, not prophylaxis 2
• Soft tissue wounds with contusion and vascular/nerve/tendon injury: Cefazolin 2g IV slow or cefamandole 1.5g IV slow, limited to operative period (24 hours maximum) 2
• Open fractures or articular wounds: Require perioperative antibiotics limited to 24-48 hours depending on severity 2

Timing Principles (When Antibiotics Are Used)

If antibiotics are indicated for contaminated wounds:

• Administer within 60 minutes before the procedure (120 minutes for fluoroquinolones/vancomycin) 2
• Discontinue within 24 hours after wound closure in most cases 2, 3
• Extended courses beyond 24 hours are not supported by evidence and increase resistance 2, 4

Important Caveats

Common Pitfalls to Avoid

• Do not confuse prophylaxis with treatment: If infection is already present or suspected, therapeutic antibiotics are needed, not prophylaxis 2
• Avoid prolonged antibiotic courses: Extending antibiotics beyond 24 hours postoperatively increases resistance without improving outcomes 2, 4
• Tissue glue complications: In ophthalmologic use, tissue adhesive can mask underlying infections and may precipitate resistant organisms with long-term broad-spectrum antibiotics 5

Special Considerations

• Prosthetic material: Even when prosthetic devices are implanted, prophylaxis should be discontinued within 24 hours (with rare exceptions for cardiac/joint prostheses where 3-5 days may be considered) 2, 6
• Pediatric tissue expanders: Studies show no difference in infection rates between perioperative antibiotics (≤24 hours) versus extended postoperative courses 7

Wound Monitoring

Rather than routine antibiotics, focus on:

• Monitoring for signs of infection: increasing pain, redness, swelling, warmth, purulent drainage, or fever 1
• Proper wound cleansing and irrigation during the initial procedure 1
• Appropriate technique and identification of predisposing risk factors 1