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Prophylactic use of topical antibiotics presents unnecessary risk during clean dermatologic procedures

Use of topical antibiotics as prophylaxis during clean dermatological procedures has shown to be ineffective, posing avoidable risk to patients, and should be discontinued, according to a recent study.

Michelle M. Levender, MD, and colleagues from Wake Forest University School of Medicine queried the National Ambulatory Medical Care Survey database for visits that occurred between 1993 and 2007, during which clean dermatologic surgery was performed, to analyze factors including provider specialty, use of topical antibiotics and the associated diagnoses.

The researchers estimated 212 million clean dermatologic procedures were performed during the time period reviewed; among these procedures, use of topical antibiotics was reported in approximately 5% (10.6 million). Dermatologists were responsible for just over 63% of these procedures, with a reported use of topical antibiotics as prophylaxis in 6% of the cases (8 million), according to the researchers. Furthermore, dermatologists were shown to be 2.5% more likely than non-dermatologists to use topical antibiotic prophylaxis in clean dermatologic procedures (6% vs. 3.5%).

“Our results reveal that a significant minority of U.S. providers are using topical antibiotics as prophylaxis in clean dermatologic surgery, despite current recommendations against this practice, which resulted in an estimated 10.6 million procedures in which topical antibiotics were probably used inappropriately,” the researchers wrote. “Increased effort must be made to uniformly modify practices in compliance with the evidence-based recommendations and to minimize unnecessary risk and cost associated with topical antibiotic use as prophylaxis.”