Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: Simple hand trauma is very common, accounting for 1·8 million emergency department visits annually in the USA alone. Antibiotics are used widely as postinjury prophylaxis, but their efficacy is unclear. This meta-analysis assessed the effect of antibiotic prophylaxis versus placebo or no treatment on wound infection rates in hand injuries managed surgically. METHODS: Embase, MEDLINE, PubMed, Cochrane Central, and the World Health Organization International Clinical Trials Portal were searched for published and unpublished studies in any language from inception to September 2015. The primary outcome was the effect of antibiotic prophylaxis on wound infection rates. Open fractures, crush injuries and bite wounds were excluded. Study quality was assessed using the Cochrane risk-of-bias tool. Data were pooled using random-effects meta-analysis, and risk ratios (RRs) and 95 per cent c.i. obtained. RESULTS: Thirteen studies (2578 patients) were included, comprising five double-blind randomized clinical trials, five prospective trials and three cohort studies. There was no significant difference in infection rate between the antibiotic and placebo/no antibiotic groups (RR 0·89, 95 per cent c.i. 0·65 to 1·23; P = 0·49). Subgroup analysis of the five double-blind randomized clinical trials (864 patients) again found no difference in infection rates (RR 0·66, 0·36 to 1·21; P = 0·18). CONCLUSION: There was moderate-quality evidence that routine use of antibiotics does not reduce the infection rate in simple hand wounds that require surgery.

Original publication




Journal article


Br j surg

Publication Date





487 - 492


Anti-Bacterial Agents, Antibiotic Prophylaxis, Hand Injuries, Humans, Models, Statistical, Surgical Wound Infection, Treatment Outcome