In a healthy adult with a superficial abrasion, what is the recommended local management, including wound cleaning, topical antibiotic (e.g., mupirocin or bacitracin/polymyxin B/neomycin [Neosporin]), moist dressing, and tetanus prophylaxis?

Local Management of Superficial Abrasion Wounds

For a healthy adult with a superficial abrasion, irrigate thoroughly with large volumes of tap water or sterile saline (100-1000 mL), apply plain petrolatum or petrolatum-based ointment (topical antibiotics are optional and not superior), cover with an occlusive dressing, and administer tetanus toxoid if the last booster was more than 10 years ago. 1, 2

Wound Cleaning Protocol

Irrigation is the cornerstone of abrasion management. The wound must be thoroughly irrigated with running tap water or sterile saline until all visible debris and foreign matter is completely removed. 1, 3

• Use large volumes of water (100-1000 mL range) rather than small amounts, as higher volumes are more effective at removing bacterial contamination and debris. 3
• Tap water is as effective as sterile saline and is superior to antiseptic agents like povidone-iodine for wound irrigation. 1, 3
• Room temperature or warm water is acceptable and more comfortable than cold water while being equally effective for cleaning. 3
• Avoid using antiseptic agents for irrigation (such as povidone-iodine), as they provide no benefit over tap water and may impair healing. 3, 4

Topical Agent Selection

Plain petrolatum or petrolatum-based ointment without antibiotics is the first-line topical treatment for most superficial abrasions after proper cleaning. 2

Topical Antibiotic Considerations

• Topical antibiotics (such as triple antibiotic ointment containing bacitracin/polymyxin B/neomycin) may be applied if the patient has no known allergies, but they are optional rather than mandatory. 3, 4
• There is no evidence that antibiotic dressings improve healing or decrease infection rates in clean wounds compared to plain petrolatum-based products. 3
• Triple antibiotic ointment remains highly effective when used, with resistance rates remaining low (only 5% among S. aureus) despite decades of over-the-counter use. 5, 6
• The combination of neomycin, bacitracin, and polymyxin B demonstrates synergistic antimicrobial activity against common wound pathogens including S. aureus, P. aeruginosa, and E. faecalis. 7

Practical Approach

• For routine clean abrasions, plain petrolatum is sufficient and avoids the small risk of contact sensitization (particularly to neomycin). 2
• Reserve topical antibiotics for wounds with higher contamination risk or when infection prevention is particularly important. 4, 8

Wound Coverage

After applying the topical agent, cover the wound with a clean occlusive dressing to maintain a moist wound environment and promote optimal healing. 1, 3, 2

• Occlusive dressings result in significantly shorter healing times compared to leaving wounds open or using dry dressings. 2
• The dressing prevents contamination while maintaining moisture that accelerates epithelialization. 4
• Wounds can get wet within the first 24-48 hours after initial dressing without increasing infection risk. 8

Tetanus Prophylaxis

Administer tetanus toxoid as soon as possible if the patient has not received a booster in the past 10 years. 4, 8

• This is particularly important for contaminated or penetrating wounds, though it applies to all abrasions in patients with outdated vaccination status. 4

Monitoring for Infection

Instruct the patient to remove the dressing and seek medical care if signs of infection develop, including: 1, 4

• Progressive redness or spreading erythema
• Increased pain or tenderness beyond the initial injury
• Swelling or warmth at the wound site
• Foul-smelling or purulent drainage
• Fever or systemic symptoms

Special Circumstances Requiring Immediate Medical Evaluation

Any wound caused by an animal or human bite, or contaminated with human or animal saliva, requires evaluation in a medical facility as soon as possible for potential systemic antibiotic prophylaxis. 1, 3

• These wounds carry significantly higher infection risk and early systemic antibiotics prevent infection, particularly in hand bites. 1
• Superficial clean abrasions do NOT require systemic antibiotics when properly cleansed and dressed. 2

Common Pitfalls to Avoid

• Do not use antiseptics for irrigation—they offer no advantage over tap water and may delay healing. 3, 4
• Do not apply ice directly to abrasions—this can cause tissue ischemia. 3
• Do not use hemostatic agents routinely—they have variable effectiveness and potential for tissue destruction. 3
• Do not prescribe oral antibiotics prophylactically for clean abrasions—reserve systemic antibiotics for wounds showing clinical signs of infection. 2, 8