Does neosporin or other antibiotic creams actually reduce infections more than say, washing the wound with soapy water? If possible, scientific studies in you answers would be nice.

-Blast

Their commercials say it does :p
For me the real bennefit of neosporin is just to keep the wound wet. I also think it serves to seal the wound from anything that might blow in.
I have nothing scientific.

Washing with soap will prevent an infection. Once an infection sets in, Neosporin will work well. It also depends on wound size and where it's located. Open wounds in joints should be flushed to prevent very serious infections, and probably should be followed by an oral regimen of Keflex, but I think in the wild if you get a serious break in the skin opening up the knee where you can see the patella, et al, it's best to flush it, apply a loose bandage to prevent more contamination and get yourself to a hospital asap so it can be X-rayed, cleaned/debridement, and sutured.

I carry a small spray bottle of hydrogen peroxide as I've found it actually works faster at eliminating small infections quickly. I may also follow up with a wash of betadine solution. This stops an actual infection in its tracks. Some don't like this method as they say it also kills some good skin cells. I think with a normal immune system, the dead cells will be replaced quickly and it's not a problem.

As for the wound healing time on a cut not infected, but with a topical antibiotic used to PREVENT infection, polysporin actually allows the wound to heal more quickly than neosporin. I have both, but the neosporin I use has a mild painkiller that has proven to be effective. Typically, I don't use it unless conditions indicate the need to lessen risk of infection. I just put a bandaid on it and let it heal itself. After a day or two, I take off the bandaid and let the air dry it out. (Again, under normal conditions -- always keep an eye on a cut until you know it's healing okay when you're afield.)

Also, you should look at the environment you are in. In humid, jungle like conditions, neosporin and other ointments work great, but in certain arid conditions flushing the wound with a betadine rinse is better. A powerdered form of neosporin can also be used for certain types of wounds.

You can't have everything with you, so I now carry the aforementioned small spray bottle of hydrogen peroxide, a few betadine swabs and a few quart size zip lock bags. I fill the bag with water, clip one bottom corner (small clip) and squeeze the bag to get an effective stream to flush the wound. This whole kit weighs little and takes up a very small space in my FAK.

As with all things we humans do, YMMV.

Unpasturized honey is another item.

Check out this experiment on the effectiveness of several
such creams and honey on lil smokey and his burnt paws.

http://www.ltwc.org/images/LilSmokeyGallery/index.htm

No scientific evidence for this, but based on a recent discussion here, next time I'm gonna try using Red Feather Butter.

Ah, Blast, medical advice you get on the internet ain't worth what you pay for it. All those posts saying, "My uncle's neighbor's cousin's Aunt Martha swears by using dog spit" aren't likely to be found in the Merck Manual.

First, this message does not in any way constitute medical advice or advocate any course of treatment. (And consult your personal physician if your pieces start turning green or falling off.)

If you search pubmed.gov for "neosporin efficacy," you'll find a mixed bag of results among a total of six papers. If you search for "topical antibiotic efficacy," you'll find 869 papers to add to your summer reading. (Adding the word "wounds" to that reduces the number to a far more manageable 85.)

Here's one quote from Diehr, S., Hamp, A., Jamieson, B., and Mendoza, M. Do topical antibiotics improve wound healing? J Fam Pract. 2007 Feb;56(2):140-4.

A clinical trial compared the efficacy of a cetrimide, bacitracin zinc, and polymyxin B sulfate gel (a combination not available in the US) with placebo and povidone-iodine cream in preventing infections in 177 minor wounds (cuts, grazes, scrapes, and scratches) among children. The antibiotic gel was found to be superior to placebo and equivalent to povidone-iodine, in that it reduced clinical infections from 12.5% to 1.6% (absolute risk reduction [ARR]=0.109; 95% confidence interval [CI], 0.011–0.207; NNT=11).2

A double-blind study of 59 patients found Neosporin superior to placebo ointment in the prevention of streptococcal pyoderma for children with minor wounds. Infection occurred in 47% of placebo-treated children compared with 15% treated with the triple-antibiotic ointment (NNT=32; P=.01)

They also note honey works well (and I think it tastes better).

I'll add these studies seem quite inadequate given the very small sample sizes. Clearly, larger studies are called for, and I wonder if too many people seal wounds (e.g., with goop and bandages) before properly cleansing them. Saline solution is your friend. I keep some stream saline nose spray in my pack. (Not the drops or mists.)

Have fun and let's be careful out there.

Since seeing My Big Fat Greek Wedding, I have used only Windex for my cuts. Trying to lower my carbon footprint with Simple Green but its not as effective.

Seriously...hydrogen peroxide and iodine is pretty much my life.

Blast, just a clarifying question--maybe I'm not understanding your question correctly, but I assume that you mean comparing "washing wound with soap and water then using nothing" vs "washing with soap and water then using antibiotic ointment". Or do you actually mean "washing wound with soap and water and then using nothing" vs "just slapping on antiobitc ointment after bleeding stops"?

Nothing disinfects a minor wound like a good old soldering gun.

I think we need to break this down more. Are we talking about a) preventing infection in a fresh (as in "just happened") wound, b) treating a wound that has become infected, or c) once you've cleaned out the wound, you're trying to prevent an infection from occurring?

The aforementioned treatment by using both flushing with peroxide and a povidone iodine solution I learned from a truama doctor WHO USED IT ON MY KNEE! This individual got his BS in biomedical engineering and was at the top of his class at the University of Chicago Medical School. For my own edification I asked if he'd mind me asking him questions while he worked on the knee and he was enthusiastic in explaining the various treatments and why some preferred one thing to another. He stated the conventional wisdom was to save the damaged tissue, but he felt with a joint wound it was worth losing a few cells to be sure he knocked out any chance of an infection once the wound was sutured.

As for medical doctors using Neosporin on wounds, I know of an actual case in Africa where a U.S. doctor was treating his knee with Neosporin and it did get infected -- but not because of any issues with its efficacy, but because in the dry conditions of southern Africa, it simply wasn't the best choice. This particular doctor was a Vietnam vet and had achieved good results with the product while a medic there. The doctor treating him in Africa said they had found it didn't work well in the dry conditions and actually used a substance banned here in the U.S. -- a flush made with Merthiolate! With 72 hours the infection was eliminated, though the doctor nearly passed out from pain when the flush was started. Older folks like me on this forum remember what Merthiolate felt like on wounds. Of interest are the comments the Zimbabwean doctor said regarding medications. He said many of the medications we take for granted in the states are simply unavailable to them and they have to resort to older treatments to achieve the same results, but that they did, in fact, get good results with treatments considered obsolete here.

Also, I need to ask this of those in the know: What are the chances of getting a MRSA infection in the wild? I thought these were generally confined to hospitals, gyms and other public areas where one can get have a small opening contaminated by body fluids of an infected individual. If anyone knows, please speak up, as this is something I need to learn.

At $83 for a 30 gm tube ($34 if ordering from Canada), it's a little pricey to be comparing to Neosporin. If you have a problem with M.R.S.A. you're a little beyond a home FAK. Neosporin is fine for cuts and scrapes.

Community-acquired MRSA is a difficult thing to estimate but according to one study cited by the CDC, they estimated that 12% of MRSA cases were acquired outside of any healthcare setting. But the prevalence of MRSA in the wild probably varies dramatically from place to place.

Many commercial products have a vast advertisement spend and give plenty of free samples to doctors.

Why are we talking about how good an ointment tastes?
Unless we are following up with an application of dog spit.

ON the MRSA question, my doctor and I talked about infections in the back woods, use of antibiotics, etc. He said any kind of dangerous infection that I would get out in the woods would probably be carried out there on my skin. We've got lots of creepy-crawlies on our skin every day. Of course that is what our immune systems are for to combat that.

Arney,

Sorry, to clarify:
1.washing wound with soap and water then using nothing

versus

2. washing with soap and water then using antibiotic ointment

Specificaly, treating a wound while away from civilization, say on a week-long backpacking trip where a quick trip to the doctor is very difficult. I want to prevent a would from becoming infected.

I understand the risk of internet-based information, that's why I was hoping for some actual reports. I'm a scientist, I used to muddling through those things.

-Blast

Hmmm, I just realized...rly45acp, by "wild" did you mean out in the bush? I was thinking of normal, everyday life, but outside of healthcare settings, which is rather different than when you're hiking/backpacking far from civillization.

I realized the distinction after reading Weldon's comment about how we take bacteria with us into the woods. That's very true. If we develop a MRSA infection in the woods, I think odds are good that it's from bacteria that we carried with us from home, not something from the wild. I'm not sure if anyone has tried to quantify that risk, though.

Here's just one study based on real wounds:

Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED.
Acad Emerg Med. 1995 Jan;2(1):4-10.

This comparison study showed that use of a number of different antibacterial ointments resulted in fewer infections later on compared to those using petroleum jelly as a control (to rule out the effect of the "keeping the wound moist and protected" idea). Triple antibiotic ointment (like Neosporin) was among the best of the antibacterial compounds tested.

This study:

Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia.
Diagn Microbiol Infect Dis. 2006 Jan;54(1):63-71.

...made me feel better about triple antibiotic ointment. It showed that Neosporin worked against even MRSA, even those samples that were resistant to Mupirocin, even though these antibiotic compounds have been in widespread use for decades.

Anyway, FWIW.

Arney,

Thanks! Thanks to everyone else, too. I've been aware of the honey treatment for many years, but Neosporin comes in much more convienent packaging.

One study isn't much to go on, though. Anyone know of a group of EMO kids we can send out into the woods...

-Blast

No, wild as in out in the bush. You're correct that normal everyday life is more wild than the wilderness, but most folks I meet think they are in "the wild" if they get twenty feet from pavement in a national park.

I live in a rural area with neighbors who come from big cities. Of course, I came from a big, high crime city too, but I was always an outdoorsman. One of these neighbors is afraid of my two Toulouse geese and another wants me to get rid of our last two remaining ducks and the two geese (which they wanted in the first place and then we took over caring for them when the neighbors realized it involved a little (very little) effort.) because they cause the Canadian geese to flock to our pond--their words, not mine. The fact that the Canadian geese come here every year to mate and raise their offspring, and we see the same pairs every year (different identifying marks on the faces), and that these geese were here for years before the domestic geese arrived escapes them! They don't want any raccoons, ducks or geese, skunks, coyotes, fox, etc., around because they defecate in their yard and the grandkids may step in it (forget about the other neighbors Labrador that drops really serious stuff!). Gee, I grew up stepping in that stuff and it included it from cows too :-), but somehow I made it all this way with no ill effects! They want to live in a rural environment sterile of any animals other than deer in the distant -- and I mean distant. If they get too close, they may eat the flowers.. The one neighbor asked me to kill the wild geese to get rid of them. I told him if he wanted them dead, he should kill them, as I enjoyed watching them. He said, and this is a quote, "I'm not a gun person and I don't like to kill things." I answer, "So what am I, the neighborhood hit man because I'm a hunter? If you want them dead, you kill them." Another neighbor put a swinging door in her garage so her cats could go out during the day. She then had fits when opossum and raccoons got in her garage and made a mess of it. She had a snake get in their too and nearly passed out. I looked at her with one eyebrow raised and asked her if she'd considered removing the door since these animals were always about at night and were very opportunistic. She subsequently had the little door blocked.

This is a bit off topic, but I think it explains why I used the term "wild" to mean wilderness.

So, what's a good brand of saline? I went to the local pharmacy recently to get some saline after reading about it here, but all of the products I saw had a whole raft of chemicals in them. I'm thinking that spraying chemicals into a wound may not be the best idea. I couldn't find anthing that was just H20 and NaCl.

Get the solution for cleaning contact lenses that does not contain a preservative. That's what they told us in First Responder class. Too get the large bottles of saline solution like you see in the hospital, etc, you need a prescription from your doctor, even though it's in a bottle and not an IV bag!

The honey needs to be the hard, unpasturized kind to both stay
put and to give all the needed benefits.

Just googled this.

dermnetnz.org/treatments/pdf/honeyforwoundcare-dermnetnz.pdf

Says it released Hydrogen Peroxide in small quantities when exposed
to the wound exudates, but not enough to damage cells as larger
amounts can.

I researched a bit at:

wikipedia.com under hand washing & I checked out neosporin at
drugs.com & wikipedia.com

Hand washing without soap flushes larger particles away from the injured area. Soap & water does a better job of removing oils & finer particles that would stick to the injured area. Soap & warm-hot water accelerates the process (but doesn't kill germs.) Antibiotic soap & warm-hot water cleans like regular soap & water but also kill many germs & temporarily prevents them from returning.

Neosporin is a combination of 3 antibiotics (bacitracin, neomycin, and polymyxin B) & a mild pain killer. The 3 antibiotics kill a wider range of germs. They are intended for topical cuts & breaks in the skin. More powerful antibiotics are mostly unneccesary at this time, & could have side effects or the patient could have undiagnosed allergies.

I find that creams can collect more dirt & grime after an application so a bandaid would be needed (especially if you were outside & continuing to expose yourself to dirt, sweat etc.) For me bandaids keep a scab from forming & closing the wound. I will often take off a bandaid at night to let it weep, air out & form a scab. Naturally, I don't want it to be completely untreated so I would use povidone iodine. I used to use rubbing alcohol or peroxide, but I heard that those damage the skin. Povidone iodine can stain cloth so I often use Hibiclens which goes on like weak cough syrup & doesn't stain as bad (or at all.) For my first aid kit I keep povidone iodine & Hibiclens in small plastic weapons oil bottles that I bought at the army surplus store. The bottles are opaque as a peroxide bottle so I don't worry about light sensitive liquid inside. The bottle tops open like an Elmers Glue bottle so I don't worry about them leaking.

Hope that helps.

Tim

Community aquired MRSA is on the rise. I managed to pick up a case, when was it, last fall or this spring, whatever (remember I have a nasty open wound for 14 months now - a skin graft was done this afternoon). We had 2 choices, 2 weeks in the hosptial on Vancomycin (sp) - IV, 2x/day, or 2 weeks of Zyvox at home. Bothe the MD and the Insurance Co (who has to pre-approve Zyvox) thought it was more likely that I would pick up 1 or more additional strains of resistant bugs in the hospital, so I spent 2 weeks on Zyvox. That is NOT a fun antibiotic - all sorts or restrictions on what you can eat/drink

It could already be living on your skin's surface. Just needs
an entry point like a blister. Most everyone has some staph
bacteria living in their nose. It could be the resistant kind.

Like your mom said "Wash your hands"

I would just like to say, "Damn, I love the board!!!" I never seem another place with so many smart people and useful information.

-Blast

"I couldn't find anthing that was just H20 and NaCl."


Hikin Jim---
My home remedy for saline is approximately 8 oz H2O, 1/8 tsp of baking soda, 1/8 tsp of table salt.

Admittedly this is my home made saline remedy for clearing my sinus passages but should translate to a stable cleaning solution for wounds. it mimics sea water but the soda cuts the harshness of the NaCl.

A few comments on this thread:

Yep, you are crawling with pathogens, and you are the source of the organisms most likely to infect your wound.

Triple antibiotic OTC lotions have a low incidence of allergic reactions and remain surprisingly effective against even most drug resistant organisms. They should not be used on extensive or deep wounds.

Hydrogen peroxide is not shown to reduce wound bacteria, but it also probably isn't harmful, either. The foaming action my provide some mechanical benefit in cleaning out a wound. It's use remains controversial.

Povidine iodine (betadine) is bacteriostatic, not antibiotic. It is used, diluted, in wound cleaning and irrigation.

Generally speaking, allowing a wound to dry out is not a good thing, as it may retard healing.

Wound cleaning and irrigation requires more than a spritz or two from a small container of nasal or otic saline solution. In the woods, where soap and clean running water are unavailable, use a large (60cc) syringe to obtain the necessary pressure and volume. Normal saline (0.9%NaCL in H20) is optimal, but clean water is fine.

For us lightweight backpackers, I recommend using a plastic Ziploc type bag full of filtered or treated water with one or two iodine swabs added, waiting ten minutes, putting a small pinprick hole in the bag, and squeezing.

Suturing is not as easy as it seems, and requires clinical judgment as well as the necessary technique. Leave it to experts. Use wound closing strips instead.

Consider taking a really good wilderness oriented first aid or EMT course if you go far away from medical care often.

I am not a doctor, nor did I stay at a Holiday Inn last night. This advice is worth exactly what you paid me for it. Consult your own darn doctor, you cheap bastard. ;-)
What I am is an experienced paramedic and disaster medical worker, as well as a long distance, solo backpacker, which means only that I have put some thought and training into treating wounds under less than optimal field conditions, and have done so, under the supervision of real doctors, perhaps thousands of times. Take it for whatever you think it’s worth.

Jeff

Thanks for your post.

Would it be possible to just use iodine tablets (e.g. Potable Aqua) and dispense with the swabs? Would doubling (tripling? quadrupling?) the usual number of iodine tabs be sufficent for wound cleansing? I'd rather not carry the swabs since they can get compromised pretty easily if their packaging gets compromised (pretty common in a full backpack), plus I rotate my iodine tabs far more frequently since I'm also using them up when I'm out on the trail.

Of course, iodine tablets take a while to dissolve. Would the swabs infuse the water more quickly?

Here's an interesting article I found. While not specific to Neosporin, and though it contains numerous typos, it is still appropriate to this discussion:

http://www.elmhurst.edu/~bio/mittermeyer/BIO216/control.html

Darn good questions. The iodine is basically the same. So the tabs would work. There is a time/dose function with iodine. Higher doeses mean less waiting time, which is nice to know if you're letting your water sit overnight before drinking, because you can use much less. I don't have any forulae or tables for that, though.

For wound irrigating purposes, you'd want a much higher concentration than you'd need for drinking. The idea is to not forcibly inject waterborne cooties into the open wound as well as to clean out the nasties already in there. Since the swabs (I'm talkin' the little gauze squares here, not the big Q-tip things) hold liquid iodine, I'd suppose they infuse the water faster than tabs.

BTW, personally, I've given up on filters for most trips, and I've had good success using resublimated iodine crystals, much like "Polar Pure." Cheaper than the little pills, and easier to adjust the dose. I don't run into many of us iodine users anymore.

Jeff

BTW, personally, I've given up on filters for most trips, and I've had good success using resublimated iodine crystals, much like "Polar Pure." Cheaper than the little pills, and easier to adjust the dose. I don't run into many of us iodine users anymore.

Jeff [/quote]

Very interesting. I've been thinking of doing the same thing. The only reason I've stayed with the filters is to remove chemicals, but away from civilization, this may not be as important.

Why not start another thread and give us more info on your reasons, etc.? I'd sure be interested.

Here is another link regarding non-antibiotic treatment of wounds. It's an easier read than the first.

http://www.worldwidewounds.com/2004/february/Cooper/Topical-Antimicrobial-Agents.html

Well, if the germs don't get you, cats and dogs will lick you to death. :P

If you can keep it sterile, your mix should be a good general purpose thing to have about. It should have a way decent job as an electrolyte booster.

Yeah. I suggest keeping the ingredients handy, and mix as needed, making it easier to keep clean/sterile.

Something every survival-oriented person should know, IMHO: Oral rehydration therapy.
http://rehydrate.org/solutions/index.html

Jeff

I spent the afternoon searching for articles on the efficacy of povidone iodine and hydrogen peroxide. It appears that these are not to be used for pressure ulcers and the like, but for cuts and such as we would see in our daily lives, about 50% said it's okay and 50% said it wasn't because it's citotoxic and has too much drying effect. As for flushing with saline, no article said anything but good things about this, so it appears to be the method of choice. This sure makes things easier for me, assuming I can find a good source for saline solution. I currently have about 11 Zerowet units on hand and this should provide me with the means to adequately flush wounds, though I think removing the syringe from the carton will make for a much smaller package.

It also appears that honey, particularly manuka honey from New Zealand or jelly bush honey from Australia, is actually being used to treat wounds in some clinical settings, including post-operative use. It has been proven to be effective against three types of antibiotic-resistant bacteria, including MRSA!

The other item worth noting was the repeated suggestion to use occlusive dressing, as they improved healing rates and prevented viral contamination. Those of you in the know can comment of any of this as you choose, as I am here to learn.

Very interesting. I've been thinking of doing the same thing. The only reason I've stayed with the filters is to remove chemicals, but away from civilization, this may not be as important.

Why not start another thread and give us more info on your reasons, etc.? I'd sure be interested. [/quote]

The reason is simple:
I'm getting older and looking to shed weight (by any means other than dieting!). 3/4 lb is not insignificant in long-disatnce backpacking.
I'm usually alone so there's no one to share group gear with.
I was carrying the iodine anyway as a back-up since I've had or seen too many filters just break or quit.
I hike in places like the high Sierras or Canadian Rockies, where the water is pretty good.
Iodine is also viricidal, and yes, it will kill cysts like cryptosporidium or giardia lamblia, too (eventually).

Jeff

Well, I cannot help but be the one who asks.

Blast-(heavy sigh!) what on Earth have you done now?

Stargazer

Uh, I bought this along with the poncho liner...

-Blast

Scientific studies are great but the real question is how well does it work for you? For me, it seems to help enough to be a useful part of my FAK. I have never been sorry to use it and a few times wished I had used it sooner. And adding a pain relief component is like frosting on a cake. IMO.

i don't leave home without it..the stuff with the pain med
is the only one worth having..get the cream not vasaline base.
i find it heals wound fast and best of all on bug bites it
kills the itching so you don't keep opening the scabs up..

Blast:

I hope you actually learn a new skill, or improving on an old one, with that axe. In the immortal words of Pink Floyd.

"Careful with that axe, Eugene." In this case Blast...

Soap and tap water are recommended in the current copy of the Merck manual. Followed with a Betadine rinse at a 1:10 ratio. I had a previous post on Betadine use here I also see where rly45acp beat me to the link at world wide wounds.

I had seen the Merthiolate trick previously mentioned from a Australian firefighter/medic. He used the solution to treat a blister on a forest firefighters foot. He injected it directly into the blister until the blister "popped." When the poor fireman stopped dancing around, he then covered it with Neosporin, gauze pads, and moleskin. Within about 48 hours the blister was almost healed. Funny thing is the other firefighters always came to me for treatment unless they were from Australia. The medic told me he had learned the treatment in the Royal Australian Navy.

Just be careful we know your reputation.

Stargazer

I agree with Jeff's comments. Hydrogen peroxides one advantage is that debrides (cleans) the wound. Yes, it probably slows healing some, and may make the scar marginally more prominent. If I didn't have adequate, appropriate flush solution at hand, but did have peroxide, I'd use without a second thought. Wound cleansing, both initial and ongoing, is the most important part of preventing infection. Once infection starts, you'll probably need oral or possibly IV antibiotics. MRSA is now a disease of civilization, not just healthcare facilities, but in the community. In the wild MRSA would be unlikely, but not impossible, “civilization” seems to touch almost everywhere.

The blister treatment seems more than just a bit extreme. Why purposefully cause a patient pain by injecting merthiolate when you'll get better results draining the blister and then simply bandaging it, apply some moleskin or Spenco 2nd Skin and you're well on your way to a 48 hour cure anyway. I don't get that one at all.

John E

Nothing scientific here, but I once took a long deep slice across the bridge of my nose. Really needed stitches, but I was stubborn. Once I got the bleeding stopped (took 'bout an hour, with lots of cold water compresses), I gooped on some Neosporin, then a little bandaid, and went on my way. Healed up fine, not even all that much of a scar (compared to my other scars at least)...

If you trust Consumer Reports, they had his to say recently. I am copying this from the August issue. I am going to quote only relevant parts to avoid potential copyright issues.

Neo spray isn't Neosporin.

"New neo to go first aid spray from the maker of neosporin displays the brand name on its label and promises "infection protection, anytime, anywhere"...

"[Neo spray] ... is neosporin in name only, it does not contain the three antibiotics in the original neosporin ointment... "

"consider [the] single use packets for the same price as the spray. Tuck a tube of neosporin ointment in your purse or backpack..."

"Clean the affected area with soap and water before applying medication, our medical consultants say."

This is only related to your original question, and I respect Consumer Reports as a source of testing and unbiased information.

Blast, I think you would fare better by looking for the names of the three antibiotics on the tube, and searching for those on the internet to see exactly what they were good for. I would be curious to hear what they said.

Thanks very much clarktx for providing the Consumer Reports info. Without it, I would've assumed that the spray is identical to the ointment.

Nurit

Neosporin=neomycin, polymyxin B, and bacitracin.

Polysporin=polymyxin B, and bacitracin.

To say "Polysporin actually allows the wound to heal more quickly than neosporin" is nonsensical. That would imply that having an extra antibiotic on board would retard healing. If you are talking about the allergic potential for Neosporin, then yes, there is a higher incidence of allergic reactions to Neosporin than to Polysporin (the neomycin may have as high as 20% allergic rxn) But this does not mean that Neosporin heals any slower than Polysporin.

I disagree that flushing with betadine is better than treating with a topical antibiotic. Betadine won't stay resident is the wound as long as the ointment. Why would neosporin work less well in a dry environment? It works great in my state: a high plains, arid environment.

Flushing a wound is great, adding some betadine is a good idea. But leave the hydrogen peroxide at home. It's heavy (liquid) and is controversial...plus it hurts! There have been studies done comparing flushing wounds with sterile water or saline vs. just tap water...guess what? Tap water may be just as good!

To say it's nonsensical is a bit of a personal attack, don't you think? First off, it's what they told us in First Responser class and second, it's based on an actual study:

Choosing an Over-the-Counter Ointment
Look under "First Aid" on any pharmacy shelf. It can be a consumer's nightmare. What to choose? An antibacterial ointment? Perhaps something labeled "first-aid cream." Or should you choose the spray the advertisements claim doesn't sting?

In one study, James J. Leyden, M.D., compared the effectiveness of nine over-the-counter products on wound healing. He found that some products are faster than others when it comes to the time it takes to mend minor cuts, scrapes, and burns. Here's what the research showed.

Polysporin (active ingredients: polymyxin B, bacitracin ointment): 8.2 days
Neosporin (active ingredients: neomycin, polymyxin B, bacitracin ointment): 9.2 days
Johnson & Johnson First Aid Cream (wound protectant with no antibiotic agent): 9.8 days
Mercurochrome (active ingredient: merbromin): 13.1 days
No treatment: 13.3 days
Bactine spray (active ingredient: benzalkonium chloride): 14.2 days
Merthiolate (active ingredient: thimerosol): 14.2 days
Hydrogen peroxide 3%: 14.3 days
Campho-Phenique (active ingredients: camphor, phenol): 15.4 days
Tincture of iodine: 15.7 days

If you do a Google search on Dr. Leyden, you'll see he has pretty good credentials. So call him "nonsensical", not me. I'm not a doctor and never claimed to be one, but was merely passing on information shared in our class since it was a state approved class, but who know? Maybe they were wrong.

The Department of Defense did a study about irrigating wounds with sterile saline vs. chlorinated water, and found the chlorinated water to be of more benefit in a field environment.

If you can't Google it, I've got a copy around here somewhere I can post. Realize that this was NOT tap water, but specific water/chlorine mix. Don't remember if the water was sterile beforehand.

Delivery agent could make a difference too. Everything has tradeoffs.

bacitracin/neosporin do make excellent fire excelerants post using your fire steel

Damn, I just sliced my finger open testing the edge of a sharpened blade for burrs. Cheap knives may not hold their edges for long, but they sure are easy to get ridiculously sharp. (We're talking scalpel sharp here.)

Thank God for bacitracin zinc, band aids, and that the universe can be forgiving to morons...

Neosporin to prevent infection and therefore promote faster healing. It contains Bacitracin which is an excellent topical antibiotic against most pathogens. Hydrogen Peroxide, while a good wound antiseptic/cleanser, actually slows down the healing time. Betadine (iodine solution) is also an excellent antiseptic and is the better alternative to hydrogen peroxide.

Just a quick add on to prior post, Betadine (povidone/iodine) is a true germicide, meaning that it kills pathogens outright, which is why it's used by surgeons as an antiseptic scrub. Neosporin or any antibiotic cream for that matter does not necessarily kill pathogens. Many simply inhibit their growth, while others have been around for so long that antibiotic resistance has developed. Remember, antibiotics originated from bacteria as a means to kill or inhibit their competition. As a result pathogens have been selected for resistance over time. This is not the case with a true germicide.

Any studies to show this?

I just read about this in my Microbiology textbook

Here's a link I found quickly enough...even though it refers to Veterinary practice...

http://answers.yahoo.com/question/index?qid=20080211065619AAkhVX1

Hydrogen peroxide damages healthy tissue surrounding the infection, which doesn't mean that it shouldn't be used, just that it does indeed slow down the healing process - to what degree probably depends on the severity, type, location, surface area, depth etc., of the infected tissue. I've also read that it actually promotes the formation of free radicals which can also damage healthy tissue.

Sorry if you took the word "nonsensical" personally. It was not meant that way. It was the phrase that didn't make sense to me. Not you as a person. You are a very rational and bright person, obviously. You don't work as a First Responder without having good judgment, problem-solving skills, etc. So again, I apologize if you took it that I was saying you personally are nonsensical.

Okay, now...NERD ALERT! Do not read on unless you really like nerdy doctorate stuff!

I actually prefer Polysporin d/t less chance of allergic reactions, but I know a few clinicians who think that's blown out of proportion and they still prefer Neosporin. Included in that camp is Dr. JJ Leyden, who says that fearing to use Neosporin is ridiculous because you have to use such large amounts to get a systemic reaction to it.

My point is this: adding neomycin to the polymyxin B and bacitracin isn't just additive, which would be better than the two alone, it is synergistic. Remember, 1+1=2, then 1+1+1=6! That's synergy. There are studies that are published in peer-reviewed journals that support this theory.

Dr. Leyden is a demigod in dermatology. I wouldn't question his knowledge or credentials for one second. But I would love to find out how many subjects he used, how he blinded the study, and, most importantly, what were the p values to indicate whether that one day was statistically significant at all!

That study is referred to in The Doctors Book of Home Remedies. There is no citation for this study. I went to the trouble to search via PubMed and, among all of Dr. Leyden's 302 (!) publications, this one is conspicuously absent. It takes millions of dollars to fund well-controlled studies with any decent population.

Dr. Leyden actually published a different study using Neosporin vs. four other antiseptic or no treatments and found that neosporin was the best. 9 days on average.J Fam Pract. 1987 Jun;24(6):601-4.

Also, to those who say good old petrolatum is just as good (that it's keeping the wound moist that's important) this study (Acad Emerg Med. 1995 Jan;2(1):2-3) showed a huge difference in infection rates when petrolatum alone was used.

If they were teaching your First Responder course from the Doctors Book of Home Remedies...then yes, there is a good chance that they were wrong about Neosporin being inferior to Polysporin.

NERD ALERT off!

Both products have only one other ingredient...white petrolatum. Delivery vehicle is the same.

BTW, someone mentioned that the neosporin spray is NOT "neosporin" ointment. I checked today at the drug store - it's Balconium Chloride, and some pain killer (can't remember which)

Good nerd! Thanks for the info with references.

-Blast

benzalkonium Cloride and Pramoxine Hydrocloride
Is whats in neo to go.

Lee

Excellent post. I can tell you've debrided a few wounds in your day...