The rational use of antimicrobial agents in simple wounds.

The wounds in most patients presenting to the Emergency Department will heal uneventfully and do not require the use of antimicrobial agents. Specific indications for antimicrobial use include simple wounds in patients with lymphedema, orthopedic prostheses, or in those patients prone to bacterial endocarditis. Relative indications include high-risk wounds in compromised hosts, wounds contaminated with feces, saliva, or vaginal secretions, or wounds clinically infected at the time of presentation. More important than antimicrobial administration is the commitment to aggressive, timely wound care. Pitfalls in therapy center around the injudicious use of antimicrobial agents. Such therapy does not give the physician permission to close wounds that should be left open or to give less than optimal wound care. Physicians should be keenly aware of the fact that antimicrobial use is not innocuous. The economic burden and potential for adverse side effects must be weighed against the fact that the wounds in 90% to 95% of patients presenting to the Emergency Department will heal without the use of antimicrobial agents.