may be a slightly increased rate of contact dermatitis with use Topical antibiotics have been noted not only to prevent infection but also to help with reepithelialization, decrease crust formation, prevent wound dehiscence, and aid in suture removal Guidelines for Systemic Antibiotics Use of prophylactic systemic antibiotics for wound management is controversial There are no data demonstrating proven benefits to the routine use of antibiotics In addition, antibiotics may lead to allergic reactions, growth of resistant organisms, altering normal gut flora, and unnecessary expense Decontamination with proper irrigation is more efficacious than routine use of antibiotics to prevent wound infection Antibiotic prophylaxis may be considered in certain high-risk wounds These include heavily contaminated wounds, wounds with devitalized tissue, bites (e.g., particularly cat, dog, and human), puncture wounds of the hand, stellate lacerations, and lacerations near joints or over open fractures Also, patients who are immunocompromised should be considered for prophylactic antibiotics Data for the role for antibiotics in intraoral wounds is conflicting There are less data supporting the use of antibiotics in dirty wounds, but may be considered in lacerations contaminated with soil or feces Wounds that result in exposed cartilage of the nose or ears or extensive facial wounds that may involve contamination from adjacent nasal passages are often treated with antibiotics It may also be reasonable to use antibiotics for wounds (other than scalp lesions) when repair takes place more than 12 hours after injury Usually, a first-generation cephalosporin or penicillinase-resistant penicillin is used to cover staphylococci and streptococci Amoxicillin–clavulanic acid is recommended for wounds created by mammalian bites (see Chapter 94 Infectious Disease Emergencies ) Additional coverage for gram-negative organisms with an aminoglycoside is recommended for open fractures (see Chapter 111 Musculoskeletal Trauma ) Methicillin-resistant Staphylococcus aureus (MRSA) in simple skin lacerations is less common, however if there is concern for high rates of MRSA in the community, then clindamycin or trimethoprimsulfamethoxazole should be considered Guidelines for Tetanus The immunization status of all injured patients should be documented in the medical record If the wound is clean and minor and the patient has received three previous doses of tetanus toxoid, a booster of tetanus toxoid is given only if 10 or more years have passed since the last dose If a patient has received three or more