Clinical and cost-effectiveness of prophylactic penicillin in the care of simple wounds undergoing suture repair - abstract

ABSTRACT

Many physicians working in Casualty and Outpatient Departments, where adverse conditions prevail, routinely prescribe antibiotic prophylaxis at the time of suture repair of simple wounds. In departments and hospitals with a busy practice in wound care, this custom may make considerable demands on limited pharmacy resources. We therefore performed a randomized, controlled study of parenteral chemoprophylaxis of simple wounds undergoing suture repair. Patients whose wounds spared neurovascular structures, tendon, and bone were randomized to either treatment with a combination of benzathine penicillin (2.4 million units) intramuscularly, or a control group. At the time of suture removal, seven days later, all wounds were reviewed for signs of infection. Of 320 patients enrolled in the study, 173 (54.1 percent) returned for review. Seventy-five of 81 (93 percent) treated wounds were healing, compared to 79 of 91 (86 percent) controls (p>0.2). A significantly higher rate of healing was observed, with prophylaxis, for wounds which were repaired 9 or more hours after injury and involved the arms, legs, or trunk (treated - 22 of 23, 96 percent; p>0,05 prophylaxis omitted - 20 of 30, 67 percent; p<0.05). Wounds involving the head, and wounds repaired within nine hours after injury had a high rate of healing (>90 percent), whether or not prophylaxis was given. Based on a 30 percent higher healing rate for the categories of patient who benefited from treatment (arm, leg, trunk wounds repaired after nine or more hours), it was calculated that the drug cost of implementing prophylaxis for this group alone was more than five times that of an expected, non-prophylactic strategy (J$33.94 vs J$6.55). These results serve to remind practitioners of the possibility that a clinically effective mode of therapy may not necessarily be cost-effective in the delivery of health care (AU)