Treatment of Simple Superficial Scratches in Healthy Adults
For a simple superficial scratch in a healthy adult, irrigate thoroughly with tap water, apply plain petrolatum (not topical antibiotics), cover with an occlusive dressing, and administer tetanus toxoid if the last booster was more than 5 years ago for contaminated wounds or more than 10 years for clean wounds. 1, 2, 3
Wound Cleaning
- Irrigate the wound with 100–1000 mL of warm tap water to remove debris and contaminants 1
- Tap water is equally effective as sterile saline for wound irrigation, with no evidence that antiseptic solutions provide superior outcomes 3
- Remove any visible foreign material or dead tissue before applying topical agents, as organic debris inactivates antiseptics 4
Topical Agent Selection
Plain petrolatum is the first-line topical treatment for superficial scratches—topical antibiotics are not recommended. 1
- Petrolatum-based ointments without antibiotics maintain a moist wound environment and promote healing 1
- The American Heart Association supports topical agents or occlusive dressings for superficial abrasions, citing significantly shorter healing times compared to no treatment 1
- There is no evidence that prophylactic topical antibiotics improve outcomes for simple wounds 3
- Moist wound care is the established standard, as it prevents wound drying and facilitates the normal healing phases 5
When Topical Antibiotics Are NOT Needed
- Simple superficial scratches and clean lacerations do not require topical or systemic antibiotics when properly cleansed and dressed 1
- For simple abscesses or boils, incision and drainage is primary treatment; antibiotics are not needed 6
- Superficial incisional surgical site infections that have been opened can usually be managed without antibiotics 6
When to Consider Antibiotics
- Reserve oral systemic antibiotics for wounds that develop clinical signs of infection: increasing pain, erythema, swelling, warmth, or purulent discharge 1
- Superficial mild wound infections can be treated with topical antibiotics, but deeper infections require oral agents 3
Dressing Application
- Apply an occlusive, non-adherent dressing over the petrolatum to maintain a moist wound environment 1
- The wound can get wet within the first 24 to 48 hours without increasing infection risk 3
- Occlusive dressings prevent contamination and are key to preventing wound infection 3
Tetanus Prophylaxis
Tetanus toxoid administration depends on immunization history and wound characteristics: 2, 3
- For clean, minor wounds: Administer tetanus toxoid if the last booster was more than 10 years ago 3
- For contaminated or high-risk wounds (e.g., soil exposure, deep punctures): Administer tetanus toxoid if the last booster was more than 5 years ago 2
- Tetanus toxoid should be given as soon as possible when indicated 3
- A case report highlights the severe consequences of failing to administer tetanus prophylaxis to a patient with a contaminated wound whose last booster was 7 years prior—she developed generalized tetanus requiring prolonged intensive care 2
Common Pitfall
The rarity of tetanus in developed countries should not lead to complacency; failure to provide appropriate post-exposure prophylaxis can result in devastating outcomes, even in previously immunized patients 2, 7
What NOT to Do
- Do not use topical antibiotics routinely for simple scratches 1
- Do not use antiseptics for wound cleansing—use tap water or saline instead 4
- Do not apply antiseptics to wounds with granulation tissue, as they can impair healing 4
- Do not assume tetanus immunity is adequate without verifying the timing of the last booster 2