American Academy of Dermatology

View all recommendations from this society

Released October 29, 2013; sources updated September 20, 2016

Don’t routinely use topical antibiotics on a surgical wound.

The use of topical antibiotics on clean surgical wounds has not been shown to reduce the rate of infection compared to the use of nonantibiotic ointment or no ointment. Topical antibiotics can aggravate open wounds, hindering the normal wound healing process. When topical antibiotics are used in this setting, there is a significant risk of developing contact dermatitis, a condition in which the skin becomes red, sore or inflamed after direct contact with a substance, along with the potential for developing antibiotic resistance. Only wounds that show symptoms of infection should receive appropriate antibiotic treatment.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Dermatology (AAD) is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions. As such, the AAD leadership created a workgroup to develop this list with specific skills and expertise in evidence based research, public health quality and payer policy. Members of this workgroup include dermatologists who are current members of the Academy’s Board of Directors, Council on Science and Research, Council on Government Affairs, Health Policy and Practice, Research Agenda Committee, Clinical Guidelines Committee, Access to Dermatology Care Committee, Patient Safety and Quality Committee, Resource-Based Relative Value Scale Committee and the Workgroup on Innovative Payment Delivery. The workgroup identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence based research as defined by the recommended criteria listed below. The recommended list was reviewed and approved by the AAD Council on Science and Research and the AAD Board of Directors.

  • Supported by available scientific evidence (e.g., existing AAD appropriate use criteria and/or existing AAD clinical guidelines)
  • Strongest consensus inappropriate score from the AAD Appropriate Use Criteria (AUC)
  • Strong (wording/level of evidence) recommendations from the guidelines about discouraged practice
  • Greatest potential for improvement in outcomes for patients
  • Greatest potential for overuse/misuse by physicians

AAD’s disclosure and conflict of interest policy can be found at


Norman G, Dumville JC, Mohapatra DP, Owens GL, Crosbie EJ. Antibiotics and antiseptics for surgical wounds healing by secondary intention. Cochrane Database of Systematic Reviews. 2016.

Dixon AJ, Dixon MP, Dixon JB. Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing. Br J Surg. 2006 Aug;93:937-43.

Smack DP, Harrington AC, Dunn C, Howard RS, Szkutnik AJ, Krivda SJ, Caldwell JB, James WD. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA. 1996;276:972-7.

Campbell RM, Perlis CS, Fisher E, Gloster HM Jr. Gentamicin ointment versus petrolatum for management of auricular wounds. Dermatol Surg. 2005;31:664-9.

Sheth VM, Weitzul S. Postoperative topical antimicrobial use. Dermatitis. 2008 Jul-Aug;19(4):181-9.

Gehrig KA, Warshaw EM. Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management. J Am Acad Dermatol. 2008;58(1):1-21

Saco M, Howe N, Nathoo R, Cherpelis B. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis. J Dermatolog Treat. 2014 Apr 8:1-8.