KIDS
March 12, 2011

Antibiotics Less Important Than Cleanliness

A study finds that properly cleaning and covering a wound has a bigger impact on healing than antibiotics do.

Simply cleaning a skin wound properly can play a greater role in healing than antibiotics do.

A study at the Johns Hopkins Children's Center set out to compare the effectiveness of two antibiotics in treating children with a skin staph infection. What they found was that cleaning, covering and if necessary, draining the wound were the most important factors in preventing infection, independent of antibiotic treatment.

The choice of antibiotic did not affect healing. Virtually all children in the study had their wounds completely healed within seven days. So something other than antibiotics must have been responsible.

It's not possible for anyone to immediately determine whether an infection is due to MRSA. This requires taking cultures from the wound and growing them, which takes days. So initial treatment choices must be made before it's clear what kind of infection one is dealing with. Because many staph infections are now resistant to common antibiotics (MRSA), the researchers reasoned that clindamycin, effective against MRSA, would work better than cephalexin, an older antibiotic effective against many common staph strains but not MRSA.

The choice of antibiotic did not affect healing. Virtually all children in the study had their wounds completely healed within seven days. So something other than antibiotics must have been responsible. The researchers conclude that conventional wound care – cleaning, covering and draining – was likely more important to healing than antibiotics were. "Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case," said Dr. George Siberry, a Hopkins pediatrician and senior investigator, in a press release.

Proper wound care has always been the cornerstone of skin infection treatment, but in recent years, use of antibiotics has begun to overshadow it. The study results may shift the emphasis back.

The researchers do not call for ending the treatment of skin infections with antibiotics. They would like to see studies that test directly whether antibiotics are beneficial for uncomplicated skin infections, or whether conventional wound care is sufficient for the wounds to heal. Such studies would help determine when antibiotics are useful for skin infections and when they're not needed. There's no reason to give antibiotics if they're not necessary and many reasons to avoid doing so.

In the study, 191 children, aged 6 months to 18 years, with skin infections that didn't require hospitalization were randomly assigned to receive one of the two antibiotics for 7 days. Essentially, there was no difference in healing between the two groups. By 48 hours, 94% of the children given the older antibiotic had improved, as had 97% of the children given clindamycin. By seven days 97% of the children given the older antibiotic were fully healed, compared to 94% of those given clindamycin.

It's not known yet whether these results are typical of all infected skin wounds.

An article on the study appears in the March 2011 issue of Pediatrics.

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