In a postoperative patient whose six‑day fever and chills have resolved but who now has localized erythema and pruritus from adhesive tape, should I prescribe systemic antibiotics?

No Antibiotics Needed for Resolved Fever with Adhesive Dermatitis

Do not prescribe systemic antibiotics for this patient—the fever and chills have resolved, and the remaining erythema with itching is consistent with contact dermatitis from adhesive tape, not infection. 1

Clinical Reasoning

Fever Timeline Supports Non-Infectious Cause

• The 6-day fever that has now resolved fits the expected pattern of normal postoperative systemic inflammatory response, which typically resolves spontaneously within 2-3 days but can persist longer after major procedures 1
• Fever occurring within the first 72-96 hours post-procedure is typically non-infectious and represents the body's normal inflammatory response to surgical trauma 1
• By day 6, if the fever has resolved rather than persisted or worsened, this strongly argues against an infectious process requiring antibiotics 1

Current Presentation Indicates Contact Dermatitis, Not Infection

The key distinguishing features here are:

• Erythema with itching (pruritus) is the hallmark of allergic contact dermatitis from adhesive tape, not infection 1
• True surgical site infections present with pain, tenderness, warmth, induration, and purulent drainage—not primarily itching 2, 3
• The Infectious Diseases Society of America emphasizes that mild erythema alone without purulent drainage, significant induration, or systemic signs does not constitute infection 1

No Indication for Antibiotics

Antibiotics are indicated for surgical site infections only when specific criteria are met 2, 3:

• Purulent drainage from the wound
• Erythema extending >5 cm from the incision with induration
• Systemic signs: temperature >38.5°C, heart rate >110 bpm, or WBC >12,000/µL
• Severe local signs: significant induration, warmth, tenderness, or necrosis

None of these criteria are present in your patient. The fever has resolved, and only erythema with itching remains 1, 2

Appropriate Management

What You Should Do

• Discontinue the adhesive tape and use alternative wound dressing materials 1
• Topical corticosteroid (e.g., hydrocortisone 1% cream) can be applied to the erythematous, pruritic areas to relieve symptoms 1
• Oral antihistamine (e.g., diphenhydramine or cetirizine) may help control itching 1
• Continue daily wound inspection to monitor for any development of true infection signs 1, 2

Critical Pitfalls to Avoid

• Do not prescribe antibiotics for non-infectious fever or contact dermatitis—this promotes antibiotic resistance and exposes patients to unnecessary adverse effects 4, 5
• Do not culture the wound unless purulent drainage or other infection signs develop 1
• Avoid treating fever alone—antibiotics should treat infections, not isolated fever 4

When to Reconsider Antibiotics

Return to evaluation if any of these develop 2, 3:

• New fever (temperature >38.5°C) after resolution
• Purulent drainage from the wound
• Expanding erythema (>5 cm from incision) with induration
• Increasing pain, warmth, or tenderness at the site
• Systemic signs of infection (tachycardia, hypotension, altered mental status)

The International Society of Chemotherapy emphasizes that colonization or mild inflammation rarely requires antimicrobial treatment in the absence of clinical signs of true infection 4. Your patient's presentation represents resolved postoperative inflammation with contact dermatitis, not an indication for antibiotics.