Intra-incisional prophylactic antibiotics for dermatologic surgery

Arch Dermatol. 1998 Jun;134(6):688-92. doi: 10.1001/archderm.134.6.688.


Objective: To determine the efficacy of intra-incisional antibiotics in decreasing the risk of wound infections in cutaneous surgery.

Design: Prospective, blinded, randomized, placebo-controlled trial conducted during an 8-month period.

Setting: A private practice Mohs micrographic surgery referral center.

Patients: Seven hundred ninety consecutive patients referred for Mohs surgery or other dermatologic surgery were randomized to receive anesthesia either with study compound or placebo. The 2 groups were equivalent with respect to age and sex distribution and the lesions treated were similar in character. No patients were withdrawn for adverse effects.

Interventions: Patients received local anesthesia before surgery with either buffered lidocaine hydrochloride or a solution consisting of nafcillin sodium in buffered lidocaine.

Main outcome measures: All surgical wounds were evaluated in a blinded fashion at the time of suture removal (5-7 days) and scored according to a standardized assessment chart based on erythema, edema, and the presence of purulent discharge.

Results: Seven hundred ninety consecutive patients with 908 surgical wounds were enrolled in this study. A total of 12 wound infections were recorded. Eleven (2.5%) of these occurred in the control group, while only 1 (0.2%) occurred in the nafcillin group. This difference was highly significant (P = .003). Observers were blinded to patient groupings particularly for surgical wound scoring.

Conclusions: This study offers strong supporting data for the use of a single intra-incisional dose of an antibiotic administered immediately before dermatologic surgery. The use of nafcillin and buffered lidocaine solution is inexpensive, safe, convenient, and effective.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Dermatology / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mohs Surgery
  • Nafcillin / therapeutic use*
  • Penicillins / therapeutic use*
  • Prospective Studies
  • Single-Blind Method
  • Surgical Wound Infection / prevention & control*
  • Treatment Outcome


  • Penicillins
  • Nafcillin