Topical Chloramphenicol Ointment Research Articles

Antibiotic Prophylaxis Prescribing Practice in Head and Neck Tumor Resection and Free Flap Reconstruction.

BackgroundAdherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumor resections with free flap reconstruction.MethodsA retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumor resection and free flap reconstruction from January 1, 2013, to February 19, 2019. Patients were divided into 2 groups, those before (pre-intervention) and after (postintervention) the education campaign. We analyzed patient demographic and disease characteristics, intraoperative and postoperative factors, and surgical outcomes.ResultsPatients pre-intervention were prescribed longer courses of prophylactic antibiotics (median [interquartile range], 9 [8] vs 1 [1]; P < .001), more topical chloramphenicol ointment (21.82% vs 0%; P < .001), and more oral nystatin (36.9% vs 12.2%; P < .001). Patients postintervention had higher rates of recipient infections (36.11% vs 17.06%; P < .001) and donor site infections (6.94% vs 1.19%; P = .006).ConclusionsFollowing the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen, and fewer topical antibiotics. However, patients also had a higher rate of surgical site infections.

Postoperative systemic antibiotic usage in elective eyelid surgery: is it really necessary?

ABSTRACT Purpose The use of prophylactic antibiotics for oculoplastic procedures varies because of a lack of specific guidelines or literature. Comparable studies in clean orbital surgery have shown no proven benefit and its indiscriminate use has been linked to individual harm and rising levels of resistance. We investigated whether avoidance of systemic prophylactic antibiotics in elective lid surgeries increased surgical site infections (SSI). Methods We conducted a case-note audit of consecutive anterior ptosis repair and lateral tarsal strip (LTS) surgeries performed with post-operative oral antibiotics (co-amoxiclav or clarithromycin) and topical chloramphenicol ointment, compared to only topical antibiotics. Data on American Society of Anesthesiologists (ASA) status, age and incidence of surgical site infection at 2 weeks follow-up were collected. Results Of a cohort of 232 patients, 99 patients had combined systemic and topical antibiotics (ptosis n = 49, LTS n = 50) and 133 had topical antibiotics (ptosis n = 83, LTS n = 50). The groups were not significantly different for age (p = .6, t-test) or ASA status (p = .7, chi2 test). Three patients from the combined group required further treatment for SSI compared with two patients from the topical antibiotic group (p = .7 Fisher’s exact test). Conclusions Avoidance of systemic antibiotic prophylaxis for LTS and anterior ptosis repair procedures was not associated with increased SSI rates. Given that prescriptions of antibiotics carry the risk of side-effects and growing antimicrobial resistance, we feel that our study shows that its routine use in this setting is of no benefit.

Outcomes of the Recombinant Human Epidermal Growth Factor Addition to Chloramphenicol Ointment for Facial Burn Wound Healing

Objective: Delayed healing of facial burns can result in scarring and psychological morbidity. Epidermal growth factor may promote wound granulation and angiogenesis to enhance wound healing. &nbsp;We compared the effect of Chloramphenicol ointment alone with Recombinant Human Epidermal Growth Factor (rhEGF) plus chloramphenicol on facial burn wound healing.Methods: A randomized controlled trial was conducted in patients admitted to the Burn Unit. Subjects aged 18 to 65 years with acute second-degree facial burn wounds that did not require surgical treatment were enrolled. Subjects were divided equally and randomized to receive either topical chloramphenicol ointment twice daily (control) or rhEGF ointment once daily and chloramphenicol ointment twice daily. Wounds were assessed at frequent intervals. Wound size, complete healing day, pain score, infection, side effects, Vancouver Scar Scale and the cost of treatment were recorded.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Results: Twenty-six wounds were enrolled. The mean wound size was similar in both groups (rhEGF plus chloramphenicol treated group 38.5±18.2 cm2 vs control group 42.1±19.4 cm2). Burn wounds in the rhEGF group healed more rapidly, though the difference was not statistically significant (8.5 ± 3.4 days vs 9.3 ± 4.4 days, p=0.3). No difference was observed in the Vancouver scar scale. Mean post-treatment pain scores were the same in both groups. There were no infections or side effects in either group. The rhEGF-treated group was more expensive (1463.1 ± 142.6 vs 19.2 ± 1.9 baht).Conclusion: &nbsp;There are no difference in outcomes of acute facial burn wound healing treated with rhEGF and chloramphenical ointment compared to chloramphenicol treatment alone. The further study to evaluate the effect of rhEGF in patients who have some factors that delay wound healing should be done.

Efficacy and adverse effects of topical chloramphenicol ointment use for surgical wounds: a systematic review.

Chloramphenicol ointment is often used in plastic and dermatologic surgery as a topical antibiotic for surgical wounds, but evidence regarding its efficacy and side effects is lacking. In addition, anecdotal fear of aplastic anaemia exists from the oral use of this drug. We performed a systematic review of the literature to assess the efficacy and side effect profile of topical chloramphenicol ointment on non-ocular surgical wounds. A systematic search of MEDLINE, EMBASE and the Cochrane Library from inception until 4 September 2017 was undertaken. Clinical studies of topical chloramphenicol ointment use on surgical wounds were included. Studies looking only at ocular use or those not available in full text or English were excluded. The review was conducted adhering to PRISMA guidelines. After full-text review, five articles were included. Two were randomized controlled trials, one was retrospective case control and two were case studies. There was evidence that chloramphenicol ointment use on surgical wounds produced a non-statistically significant reduction in infection rates. Delayed hypersensitivity and acute oesophagitis were noted as potential side effects of non-ocular topical use. Aplastic anaemia was not reported. There is a paucity of clinical data regarding the use of topical chloramphenicol ointment on surgical wounds. Further randomized controlled trials may be beneficial in order to support or refute its use in this setting.

Initiating a transfusion protocol for free diep flap breast reconstruction in North Bristol NHS Trust

Initiating a transfusion protocol for free diep flap breast reconstruction in North Bristol NHS Trust

Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial

Objective To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery.Design Prospective randomised placebo controlled double blind multicentre trial.Setting Primary...

Recurrent Staphylococcal Conjunctivitis Associated With Facial Impetigo Contagiosa

To report the uncommon occurrence of impetigo contagiosa in the setting of recurrent staphylococcal conjunctivitis. Interventional case report. A 32-year-old patient had a recurrent painful red left eye and facial rash. Clinical examination revealed left bacterial conjunctivitis and facial bullous impetigo. Microbiology cultures were taken from the nose, conjunctiva, and facial lesions. Microbiologic cultures grew Staphylococcus aureus, and hematology findings demonstrated an elevated white cell count with neutrophilia. Complete resolution was achieved with topical chloramphenicol ointment and oral dicloxacillin. Although uncommon, bullous impetigo may be associated with recurrent staphylococcal conjunctivitis in adults. Recurrent infections may require nasal decolonization, systemic antibiotics, and antiseptic body wash.

Role of topical antibiotics in hip surgery: A prospective randomised study

The effectiveness of topical antibiotics has been shown well enough in vitro to justify strong consideration of their use in orthopaedic procedures. We carried out a randomised prospective trial to study the role of topical chloramphenicol ointment application on postoperative wounds following surgeries for hip fractures. One hundred cases with fracture neck of femur were enrolled in the study. They were randomized into two treatment groups: one group had chloramphenicol ointment applied at the surgical site at the end of procedure and 3rd day postoperatively, while the control group did not. The wound was checked on the 3rd, 6th, 12th and 30th days postoperatively, by a tissue viability nurse on the guidelines issued by the Scottish Centre for Infection and Environmental Health (SCIEH). We had 12 cases with superficial infection of which 8 belonged to control group. The risk of developing wound infection, however, was not significant with and without the use of chloramphenicol ointment (relative risk 0.430, 95% confidence interval (CI) 0.120-1.544). Using multivariate analysis, no association was found between wound infection and age, gender, type of fracture or type of surgical procedure. Smoking was found to be the only factor significantly associated with infection, with the relative risk for current smokers compared with former/non-smokers being 7.29 (95% CI 1.62-32.67). Awareness is needed amongst the general public about the ill effects of smoking. There was reduction in the incidence of wound infection with the use of topical antibiotic ointment. However, this was not statistically significant to recommend its use in routine practice. A larger study should provide useful information on the role of topical antibiotic and its effect on postoperative wound infection.