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may be a slightly increased rate of contact dermatitis with use. Topical antibiotics
have been noted not only to prevent infection but also to help with
reepithelialization, decrease crust formation, prevent wound dehiscence, and aid
in suture removal.
Guidelines for Systemic Antibiotics
Use of prophylactic systemic antibiotics for wound management is controversial.
There are no data demonstrating proven benefits to the routine use of antibiotics.
In addition, antibiotics may lead to allergic reactions, growth of resistant
organisms, altering normal gut flora, and unnecessary expense. Decontamination
with proper irrigation is more efficacious than routine use of antibiotics to prevent
wound infection. Antibiotic prophylaxis may be considered in certain high-risk
wounds. These include heavily contaminated wounds, wounds with devitalized
tissue, bites (e.g., particularly cat, dog, and human), puncture wounds of the hand,
stellate lacerations, and lacerations near joints or over open fractures. Also,
patients who are immunocompromised should be considered for prophylactic
antibiotics. Data for the role for antibiotics in intraoral wounds is conflicting.
There are less data supporting the use of antibiotics in dirty wounds, but may be
considered in lacerations contaminated with soil or feces. Wounds that result in
exposed cartilage of the nose or ears or extensive facial wounds that may involve
contamination from adjacent nasal passages are often treated with antibiotics. It
may also be reasonable to use antibiotics for wounds (other than scalp lesions)
when repair takes place more than 12 hours after injury.
Usually, a first-generation cephalosporin or penicillinase-resistant penicillin is
used to cover staphylococci and streptococci. Amoxicillin–clavulanic acid is
recommended for wounds created by mammalian bites (see Chapter 94 Infectious
Disease Emergencies ). Additional coverage for gram-negative organisms with an
aminoglycoside is recommended for open fractures (see Chapter 111
Musculoskeletal Trauma ). Methicillin-resistant Staphylococcus aureus (MRSA)
in simple skin lacerations is less common, however if there is concern for high
rates of MRSA in the community, then clindamycin or trimethoprimsulfamethoxazole should be considered.
Guidelines for Tetanus

The immunization status of all injured patients should be documented in the
medical record. If the wound is clean and minor and the patient has received three
previous doses of tetanus toxoid, a booster of tetanus toxoid is given only if 10 or
more years have passed since the last dose. If a patient has received three or more