As a physician, I demur: avoid anything but copious irrigation with water ± bandage.
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The last time I did a first aid course, they really pushed the idea of just water and bandages. They cautioned against the use of other ointments as well as alcohol and peroxide as they can dry out the wound, prolonging healing. It certainly went against everything I feel like I would normally do, but it makes sense.
I'd be curious if this is a recent* change in methods, or a recent* push to ensure people are doing it.
*recent being the few years between when I've taken first aid courses.
If I'm reading that correctly, you're arguing against antibiotic or sterilizing agents in favor of extensive rinsing without only water.
It certainly wouldn't surprise me to hear that Neosporin et al are usually unnecessary, but are they actually bad? And if they're bad because antibiotic resistance, are things like hydrogen peroxide and rubbing alcohol also bad?
I think doc is saying, "Please don't make your wound worse with dubious remedies before you come in to show it to me."
Your mouth is full of bacteria, some of which could be harmful when introduced into an open wound. Your home first-aid kit is unlikely to be perfectly sterile, or as versatile as an entire medical clinic. If you are in the wilderness, and licking is the only means you have at your disposal to clean a wound, go for it. Your mouth is less dirty than actual dirt. Otherwise, use filtered, boiled water to wash, and a clean, sterile bandage to dress. [A single application of] antibiotic ointment is unlikely to hurt, but painting the surrounding skin with iodine would be better, and that kind of antimicrobial power isn't typically found at home, unless you have livestock and didn't care for the magnitude of your vet bills.
Published August 2017
Povidone iodine in wound healing: A review of current concepts and practices
Abstract
BACKGROUND: Of the many antimicrobial agents available, iodophore-based formulations such as povidone iodine have remained popular after decades of use for antisepsis and wound healing applications due to their favorable efficacy and tolerability. Povidone iodine's broad spectrum of activity, ability to penetrate biofilms, lack of associated resistance, anti-inflammatory properties, low cytotoxicity and good tolerability have been cited as important factors, and no negative effect on wound healing has been observed in clinical practice. Over the past few decades, numerous reports on the use of povidone iodine have been published, however, many of these studies are of differing design, endpoints, and quality. More recent data clearly supports its use in wound healing.
METHODS: Based on data collected through PubMed using specified search criteria based on above topics and clinical experience of the authors, this article will review preclinical and clinical safety and efficacy data on the use of povidone iodine in wound healing and its implications for the control of infection and inflammation, together with the authors' advice for the successful treatment of acute and chronic wounds.
RESULTS AND CONCLUSION: Povidone iodine has many characteristics that position it extraordinarily well for wound healing, including its broad antimicrobial spectrum, lack of resistance, efficacy against biofilms, good tolerability and its effect on excessive inflammation. Due to its rapid, potent, broad-spectrum antimicrobial properties, and favorable risk/benefit profile, povidone iodine is expected to remain a highly effective treatment for acute and chronic wounds in the foreseeable future.
Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA.
Int J Surg. 2017 Aug;44:260-268. doi: 10.1016/j.ijsu.2017.06.073. Epub June 23 2017.
http://www.journal-surgery.net/article/S1743-9191(17)30536-8...
[citation appreciated]
(family physician)
In my experience, the issue with Neosporin (besides selecting for resistant bacterial populations) is that people develop a rapid counterreaction if they use it too long. The same applies to so-called "triple antibiotic ointments" and such.
Peroxide and isopropanol are more of an issue for healing, since they can be toxic to tissues.
Just keep it clean and let the body sort it out.
(microbiologist)
I agree on keeping it clean and avoiding antibiotics in superficial situations, but I'm surprised by a concern regarding peroxide. Any cut with any depth I have that may have anaerobic potential at all, I use early and often. Anerobes can be tough, and I've not sensed tissue toxicity from Peroxide, (Isoproanol, for sure).
Any reactive oxygen species, of which peroxides are the classic type, can cause oxidative damage in cells. There's a reason we have catalase and peroxidases.
This isn't to say there isn't a role for topical antiseptics, but that role is probably right at the beginning after the wound is sustained. I'll go with "early" but definitely not "often."
A fair view regarding limiting prolonged usage, especially if the wound remains well vascularized and there is reasonable expectation of immune surveillance. I'm probably less of a germ-o-phobe than 99.9% of folks but deep infections and antibiotic resistance are things that keep me up at night, so I'm gonna always be a bit of a H2O2 junkie :]
Interesting exchange, thanks. I knew peroxide and isopropanol cause some cell damage, but didn't know if it was significant enough to impact healing. I also didn't know isopropanol was worse for this than peroxides? (If that is what you're saying?)
The general stance here makes sense, though; possibly one non-antibiotic clean on a fresh injury, then just leave it alone.
my view on that is that isopropanol is less discriminate in it's toxicity that hydrogen peroxide. as mentioned above, our cells (but not those of bacterial that live without oxygen) have enzymes such as peroxidase, catalyase, and Superoxide dismutase which fight oxygen radicals(how peroxide works to kill cells). Granted as mentioned above, pouring peroxide on surely overwhelms this system to some extent, so some damage can occur perhaps slowing healing. Isopropanoal just 'drys-out' and denatures every thing it hits pretty much.
I'm not sure which is worse, but I don't think either are helpful beyond the very very short term.
Not to pretend I know more than a doctor, but I use Betadina/iodine on cuts and find I have a lot less issues with infection, especially if it's something like a cut on your foot as your foot is usually in a shoe.
I find this to be especially true if you're in a dirty environment such as when you're hunting or hiking.
I've verified that antibiotic creme and bandage work better than bandage for myself. I understand ~10% have allergic reactions. Are you optimizing for a corner case?