Prophylactic antibiotics in patients undergoing laser resurfacing of the skin

Background: Carbon dioxide (CO2) laser resurfacing produces a superficial s econd-degree burn that needs to be protected from bacterial and fungal infe ctions. Objective: We investigated the effects of various systemic and topical anti microbial regimens. Methods: Four different regimens using oral ciprofloxacin, topical antibiot ics (intranasal mupirocin ointment and otic solution), oral ketoconazole, a nd oral fluconazole were tested in four time periods. The frequency and typ es of the infections with various regimens was compared. Results: The study included 356 sequential patients who underwent facial CO 2 laser resurfacing. Infections occurred in 27 patients (7.6%). Without ant ibiotic prophylaxis, 8.2% of patients had bacterial infections from days 3 to 12 after the procedure (average, day 5). With prophylactic ciprofloxacin only, 4.3% of patients had bacterial infections; these occurred almost exc lusively after ciprofloxacin was discontinued. For 7 months, patients were randomly assigned to either receive or not receive mupirocin intranasally, All Staphylococcus aureus infections that occurred were seen in patients wh o had used intranasal mupirocin. Yeast infections were seen in 6 patients ( 1.7%), but mostly occurred more than 10 days after the procedure. Yeast inf ections were of approximately equal occurrence in the ciprofloxacin group ( 2.2%) and in the non-ciprofloxacin group (1.8%). No yeast infections occurr ed in patients who had undergone antifungal prophylaxis. Conclusion: Post-CO2 resurfacing infections are not rare but can appear sub tly and might only be noticeable in the second postoperative week. Prophyla ctic intranasal mupirocin is ineffective, but ciprofloxacin is effective in preventing infection with both gram-positive and gram-negative bacteria. O ral ketoconazole and fluconazole are effective in preventing yeast infectio ns.