Antibiotics and wound care

The Pediatric Insider

© 2012 Roy Benaroch, MD

“Why do some doctors prescribe antibiotics when a child needs stitches? Are they always needed?”

There aren’t any hard-and-fast rules. Whether antibiotics are needed depends on the risk of infection, and how serious the infection is likely to be if it occurs.

After any wound (whether sutures are needed or not), the most important step to prevent infection is thorough cleaning. Washing out a wound well with plenty of running water is very safe and effective, and it’s the single best way to prevent infection. The water doesn’t have to be special medical sterile water. Just plain old tap water is fine, squirted out of a faucet or hose. Rinsing with peroxide or other antiseptics is OK if you can’t get to running water, but really isn’t necessary or superior to a good hose or sink wash. Topical antibiotic ointments might help some, but are also second-best to a good cleanout.

There are times when it’s difficult or impossible to clean a wound well, and that’s one reason to consider taking oral antibiotics. Deep wounds from a nail or a deep cat bite can be very hard to clean out well.

Other reasons to consider oral antibiotics: a wound that includes a lot of bruising or “crush” may be more likely to get infected because the blood supply (and thus, the supply of infection-fighting cells) might be disrupted. Similarly, anyone with poor circulation (like a diabetic) is more likely to have a wound infection. Sometimes we’re also more likely to prescribe antibiotics if the wound is in a place that’s very cosmetically important.

Whether or not oral antibiotics are prescribed, look out for any signs of a wound infection. Though most infections aren’t serious, some can cause big problems if they get out of hand. Signs of a wound infection include increasing pain, oozing, warmth, and spreading redness. If these occur, contact your doctor.

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