Single Dose Flucloxacillin in the Treatment of Wounds

Abstract

Systemic antibiotics are frequently prescribed to patients presenting with contaminated soft tissue wounds in an attempt to prevent development of wound infection. The efficacy of antibiotics employed in this way has not been established. A double blind, randomised clinical trial to investigate prophylaxis against wound infection in the initial treatment of contaminated wounds was carried out in a hospital accident department. A single oral dose of flucloxacillin 1g was compared with a five-day oral course of flucloxacillin 250mg six hourly. All patients also received long-acting intramuscular penicillin ('Triplopen'). Wounds were assessed seven days after initial treatment using a scored telephone questionnaire. Patients were asked about swelling, redness, pain and exudate associated with their wounds. In cases where the wound assessment suggested the presence of infection, wound swabs were taken if at all possible. 238 patients with contaminated soft tissue wounds were entered into the trial and 202 (85%) were successfully followed up. 100 patients received the single dose of flucloxacillin of whom five were judged to have developed wound infections. 102 patients received the five-day course of whom six developed wound infections. Chi-square analysis of the infection rate in the two treatment groups gave a calculated value, with Yates’ correction, of x2 = 0.18, (P>0.67), a clear indication of no association between the dosage regime of flucloxacillin and the wound infection rate. In the clinical situation, pathogenic micro-organisms may often be exposed to levels of antibiotics below the minimum inhibitory concentration and such exposure may alter their susceptibility to phagocytosis. Brief investigations: showed that for two clinical isolates of Staphylococcus aureus, a common wound pathogen, low concentrations of flucloxacillin affected bacterial surface hydrophobicity but had little effect on whole blood killing.