Prophylactic and therapeutic role of antibiotics in wound care.

Even though surgical infection rates have decreased dramatically during the past 25 years, questions and clinical problems with respect to prophylaxis, diagnosis, and treatment remain. After it was realized that widespread use of antibiotics resulted in a rise of resistant organisms, indiscriminate use of these drugs was curtailed. Studies soon showed that antibiotic prophylaxis for a limited period of time was not only effective, but also reduced the incidence of side effects. Today, clean surgical procedures that involve no implantation of a prosthesis do not warrant routine antibiotic use. Prophylactic antibiotic coverage is indicated for clean contaminated or contaminated surgical procedures, and dirty wounds need both prophylactic and therapeutic antibiotic use. The most effective administration route of prophylactic antibiotics remains a matter of discussion. With respect to open wounds, antibiotic-containing topical wound treatments are widely used, even though their efficacy has not been established. Open wounds do not have to be sterile to heal, and the emergence of allergy, sensitivity, and resistant organisms following the use of these topical treatments is of concern. Controlled clinical studies are needed to provide us with more definitive guidelines on these issues. In the meanwhile, we do know that meticulous surgical and nursing techniques, as well as surveillance of infection rates, are important in achieving and maintaining a low infection rate.