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Petrolatum vs. Bacitracin for Skin Surgery Wound Care

Antibacterial ointments including bacitracin, Polysporin, and Bactroban are routinely used for wound care after dermatologic surgery to reduce infections and to provide a moist healing environment. However, some patients develop allergic contact dermatitis. This randomized, double-blind, prospective trial compared white petrolatum and bacitracin ointment for postoperative wound care in 922 patients who underwent dermatologic surgery. Patients with bacitracin sensitivity were excluded.

A total of 884 patients with 1207 wounds completed the study. Clinical signs of infection developed in 3.6% of wounds in the petrolatum group and 2.7% in the bacitracin group. Culture confirmed the infections in 1.6% of the petrolatum-treated wounds and 0.7% of those treated with bacitracin. Of the wounds with documented infection, Staphylococcus aureus was cultured from 9 of 10 in the petrolatum group and Gram-negative rods from 4 of 4 in the bacitracin group. Allergic contact dermatitis developed and was confirmed by patch testing in 0.9% of patients in the bacitracin group and none in the petrolatum group. The only statistically significant difference between the two groups was the frequency of S. aureus wound infection.

Comment: White petrolatum appears to be a safe and much less costly alternative to bacitracin ointment. There seems to be no significant increase in wound infections with petrolatum, and the risk of allergic contact dermatitis is eliminated. Bacitracin selects for Gram-negative organisms, which can cause infections that may require more expensive antibiotics to treat than S. aureus infections.

The use of antibacterial ointments is so universal that many more studies like this one will be needed to convince dermatologists to switch to petrolatum for routine postoperative wound care.

— GJ Hruza

Published in Journal Watch Dermatology November 1, 1996

Citation(s):

Smack DP et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. JAMA 1996 276 972-977.

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