Topical Antibiotics Lower Infection Risk After Periocular Surgery
Ophthalmology, December 2020
Topical antibiotics are commonly used after routine oculofacial plastic surgery. Considering the overall low infection rates for clean and clean-contaminated wounds, along with concerns about antibiotic resistance, drug-related adverse events, and health care costs, Ashraf et al. questioned whether topical antibiotics make a significant difference after oculofacial plastic surgery. They found that patients who used an antibiotic ointment had a much lower risk of surgical site infection (SSI).
For this randomized, placebo-controlled study, 401 adults were recruited from a clinic population undergoing periocular surgery. Patients were assigned randomly to receive a post-op antibiotic or placebo. Within the antibiotic group (n = 208), treatments were chosen randomly and consisted of 0.5% erythromycin ophthalmic ointment, bacitracin zinc ophthalmic ointment, or bacitracin zinc plus polymyxin B sulfate. The placebo group (n = 193) received one of four ophthalmic lubricant ointments consisting only of mineral oil and petrolatum. All participants were instructed to apply their ointment four times daily for seven days. The primary outcome measure was the frequency of SSI (superficial or deep) at the first post-op visit, which took place seven to 14 days after the surgery. The incidence of allergic contact dermatitis was a secondary outcome.
The most common procedures in both study arms were blepharoplasty; repair of ptosis/ectropion/entropion; reconstruction after Mohs surgery; and eyelid lesion removal or biopsy (or both).
A modestly higher rate of infection was observed for the placebo group (2.7% vs. 0% for the antibiotic group), but the difference between groups was significant (p = .025). Contact dermatitis was rare, occurring in only one patient of each group.
The authors acknowledged that their study was limited by the lack of SSI in the active-treatment group, which precluded any subanalyses. (Also see related commentary by Jeremiah P. Tao, MD, in the same issue.)
The original article can be found here.