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ANTIBIOTICS IN DERMATOLOGIC SURGERY

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SUMMARY

  • The rate of infection after skin surgery is likely between 1% and 4%.

  • Antibiotic use in dermatologic surgery has declined markedly over the past several decades, as studies highlighting the baseline low rate of wound infections, coupled with the individual and societal risks associated with widespread antibiotic use, have made the routine prescribing of perioperative antibiotics no longer the standard of care.

image Beginner Tips

  • The differential diagnosis of postoperative infection includes irritant or allergic contact dermatitis, suture reactions/suture abscesses, filler reactions (if relevant), and inflammatory chondritis.

  • Contact dermatitis should be considered, particularly when topical antibiotics or adhesives were used, or when the involved area is geometric.

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  • Risk factors for infection include patient factors, surgical factors, and surgical site factors.

image Don’t Forget!

  • Cephalexin or dicloxacillin can be used as prophylaxis for wedge excisions of the lip or ear, flaps on the nose, and grafts.

  • Clarithromycin, levofloxacin, TMP-SMX, metronidazole, and ciprofloxacin are associated with a higher risk of hypoglycemia in diabetic patients taking sulfonylurea medications.

image Pitfalls and Cautions

  • While antibiotics are typically given the hour before the procedure, there is ambiguous data about whether prophylactic antibiotic timing affects the risk of superficial skin infection.

  • Given the high rate of warfarin and sulfonylurea use in the patient population undergoing dermatologic surgery, systemic antibiotics should be prescribed with extreme caution and an eye to minimizing the risk of drug–drug interactions.

image Patient Education Points

  • No rigorous study has demonstrated a robust statistically significant benefit to utilizing any single topical antibiotic preparation, and the American Academy of Dermatology has, therefore, warned against the routine use of topical antibiotics after clean surgical procedures as part of its Choosing Wisely campaign.

  • Patients often request perioperative antibiotics under the assumption that these will decrease their risk of developing an infection; therefore, adequate education may be valuable in dissuading patients from this practice and increasing their comfort level.

  • It may be helpful to explain to patients that bacteremia is more likely after brushing their teeth than it is postoperatively.

INTRODUCTION

Antibiotic use in dermatologic procedures has declined markedly over the past several decades, as studies highlighting the baseline low rate of wound infections, coupled with the individual and societal risks associated with widespread antibiotic use, have made the routine prescribing of perioperative antibiotics no longer the standard of care. Those performing dermatologic procedures must understand the subtleties of antibiotic choice not only to guide clinical patient management, but also to elegantly explain to patients why they would—or would not—benefit from antibiotic use in the perioperative period. An anxious patient can often be easily calmed by providing a reasoned explanation of the scientific basis of the clinician’s decision to decline a patient-suggested antibiotic prescription. Understanding both the scientific literature as well as society-level recommendations regarding antibiotic use is ...

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