Purell instead of Triple Antibiotic Ointment?

Here is what I do when I see that a blister is forming. First, I take one of those pre-made thin blister pads and put it on the wound. Next, I take mole foam, fold it in half, cut out a triangular or semicircular shape, unfold the moal foam, leaving a diamond or circular hole in the mole foam, and put the mole foam over the blister pad. Then I duct tape the whole thing.

The purpose of the mole foam in this arrangement is to make some space between the wound and the boot, so that the boot is not directly touching the wound. I have had much better success with mole foam than with mole skin. I carry only mole foam now – no mole skin.

I find that without the duct tape, the mole foam comes off. With the duct tape, the setup stays in place long enough to last the day.

98% of my hiking is in day hikes, so my needs are not as demanding as those for people going on multiday hikes. Duct works ok for me. Maybe people going out for longer periods would want to use use some other tape for this setup, e.g., leukotape.

I'm thinking that gauze with a hole cut into it in the same way as above with the mole foam, and maybe folded over a few times, would do exactly what the mole foam does – provide a space between the wound and the boot. If so, then I could carry only the gauze, and ditch the mole foam. Mole foam is extremely light, and carrying it around is not bad at all, but it'd still be nice to be able to get rid of it in order to reduce the number of items in the pack. Simplicity is good.

Mupuricon (trade name Bactroban) is probably a better choice than "triple ointment". Broader coverage and more potent. Neomycin hypersensitivity rxns are a problem as people are increasingly exposed to neomycin. Usually mild — cut will itch. In the US, you will need a script for mupuricon ointment. Of course, there exists a great controversy as to whether we should be using any of this stuff without evidence of infection! Soap and water is the most important thing.

Have come across estimates that hypersensitivity reaction to this drug may be as high as 15-20%. Of course, this would depend on prior exposure to the drug.

"there exists a great controversy as to whether we should be using any of this stuff without evidence of infection!"

No controversy in my mind a'tall. If I want to continue hiking without threat of infection, the cut gets the antibiotic immediately. The last time I didn't give a minor scrape an antibiotic I had a lot of medical bills. I don't have the resources right now to take risks, thanks.

I'm not a medical doctor, and at the risk of wading into this issue, my experience has been that it's entirely appropriate to treat a cut or scrape with small amounts of topical antibiotic ointment to prevent infection. Prevention in this case is worth a pound of cure; if a cut on your foot gets infected to the point where you can't walk on it and you're 15 miles out, that can get very bad very quickly.

I think the controversy is over other, less appropriate uses such as the ubiquitous, every day use of antibacterial soap (my understanding is that this soap doesn't improve cleanliness and may foster the growth of resistant strains on your hands, not such a good situation when you DO get a cut or scrape!)

Or the request some people make of their doctors for broad spectrum antibiotics for a cold. Colds are viral, not bacterial and usually run their course anyway, the only thing an antibiotic would do is kill all the healthy bacteria in your gut giving you digestive problems and again, fostering the growth of resistant bugs.

>If your antibiotic wipe is an alcohol swab, this would damage your wound. Leave it out to dry for a while and you might reduce the risk.

Note: Please see previous posts on this thread. An alcohol swab is, as I understand it, antiseptic, not antibiotic. The pads/ wipes soaked in antibiotics work pretty well as the "gauze" part of a bandage. As for the sticky part, take your pick.

To each his/ her own on this point, but IMO alcohol and other antiseptics are of very limited use here because their bacteria-killing powers disappear as soon as the alcohol evaporates. Antibiotics stay on the wound and prevent long-term infection. Given how far you are from a hospital on most-long term hikes, I'd treat every cut and scrape as a potential opening for an infection.

Stargazer

"Note: Please see previous posts on this thread. An alcohol swab is, as I understand it, antiseptic, not antibiotic. The pads/ wipes soaked in antibiotics work pretty well as the "gauze" part of a bandage. As for the sticky part, take your pick."

So you would slap an alcohol wipe on an open wound and tape it down because it's an antiseptic? Despite the warnings upthread that prolonged exposure to alcohol can cause damage? I'm not disagreeing with the use of alcohol – I use it then apply the antibiotic with some sterile gauze for wrapping. But as you say, alcohol evaporates quick. Unless you use it for dressing, which prolongs the exposure to alcohol, which can cause further damage.

I'm with Lori on this. Every little thing gets a smear of Bactroban (much better than triple ointment in terms of microbial coverage, does require a script) and I'm sensitive to neomycin. Similar rationale! I swear things seem to heal faster! But there is very little evidence that such an approach is useful. Soap and water should be enough when it comes to managing minor wounds. Though I DO use antibiotic ointment in the absence of infxn, I doubt that this practice is very useful!

this could actually slow down the healing process, as it kills cells regardless of whether they're nice or bad :D

i carry triple antibiotic for cuts and use the purell for washing my hands

Not to mention alcohol on an open wound hurts like a MOFO.

I do use alcohol to sterilize the abrasion and the surrounding area – and let it dry before applying actual medication. Fortunately it takes no time at all to evaporate.

My understanding is that the current preferred method of cleansing a wound is with clean water or saline solution, NOT alcohol or other antiseptic products. Antiseptics can kill living tissue and haven’t proven to be more effective than irrigation. Water irrigation requires pressure to be effective, so I carry a small syringe in my first aid kit. It’s been suggested in the past that a water-filled ziplock bag with a clipped corner can be used for irrigation in a pinch but there’s debate on whether that provides enough water pressure. Here’s a good synopsis of first aid treatment for wounds, including info on irrigation.

G

Gordon, I'm afraid you are CORRECT. Despite the evidence to the contrary, there are those of us (me included) who think we need a little smear of antibiotic ointment — this probably isn't going to hurt us. Placebo effect can be powerful. But let's not be fooled — such ointment is NOT an effective substitute for thorough cleaning (with water and perhaps a drop of dr. bronner's) and drying of the wound. Of course sterile saline is ideal but who wants to carry it. The syringe is a great thing to have in the case of gashes and punctures. Would not care to muck up a wound with Purell and all it's perfume and other additives. As always, current tetanus immunization. Recommendations I believe are every 10 years after initial series. Can probably go some years longer.

If you are recently fallen on a granite slab and in a world of hurt not to mention panic, afraid that you have cracked your tailbone, broken your wrist and thumb, and imagining that the rocks you see surrounded by blood in your fleshy palm are really ends of bones, a little water dribbled from your bite valve really sets your mind at ease quite well. With no third hand, I used what I could as best I could, and pressurized water jets were out of the question. Stopping the bleeding and tweezers had to do.

On the subject of bismuth, this is the active ingredient in Pepto-Bismal. It is much studied and known to have antimicrobial properties in the gut. This is the first mention I've seen of it being used topically. Would probably throw it in with all the other antibiotic ointments as far as initial wound management goes — probably doesn't matter either way. Certainly, no substitute for cleaning with water and a little gentle soap.

Backpacker Chick writes:
"Despite the evidence to the contrary, there are those of us (me included) who think we need a little smear of antibiotic ointment — this probably isn't going to hurt us."

To be clear, I did not mention antibiotic ointment in my post. My understanding is those ARE recommended to be applied to a wound once it is clean. I am talking about antiseptics such as alcohol or peroxide used for initial sterilization. Irrigation with clean water should be used for initial cleansing instead of those.

G

Gordon, thanks for clarifying. Anyway, I think you've hit on the most important aspect of wound management! Flushing it with water. Never heard of cleaning a wound with Purell — sounds icky and very irritating — perfume and stuff. Ointments tend to create a bit of a seal between the wound and the outside world so you may end up sealing "germs" in.

"Mupuricon (trade name Bactroban) is probably a better choice than "triple ointment". Broader coverage and more potent."

Spot on. It's the same stuff they prescribe for applying in your nasal passages to kill off MRSA. It's a highly effective antibiotic. It's what I carry in my 1st aid kit.
Only downsides are the weight: ~ 1 oz. and the fact that it requires a prescription.

I had an assignment at a NZ hospital and had to do the MRSA swabs. Was negative. Many people were hoping they were carriers as they would get something like 6 weeks off with pay — and they aren't even sick! I think testing for MRSA carriage has gone out of vogue. I think about 20% of us are carriers. Sorry off topic but it's an off-topic kind of day.

BTW, the last place you want to find out about neomycin sensitivity is the nose. Years ago, pre-bactroban, had an ENT prescribed neomycin for use in my nose. Really irritating — sinuses, crying.

If you're traveling abroad, can often pick this stuff up — "pharmacist's discretion" exists in a lot of countries. This also goes for tinidazole, levofloxicin, cipro, analgesics (tend to be stricter here!) and other drugs one tends to carry.

If you have any reason to visit an MD or other provider, always enquire about sample tubes of bactroban, steroid creams, etc. regardless of what brought you in! Also, mini sample inhalers if this is something you carry! These little tubes are precious! A regular size tube of bactroban would last me a decade probably if the tube didn't fall apart. A little goes along way. The problem with the sachet packets is that they have about a week's worth of ointment (for a small laceration) and there's not really a good way to close them.

Saw a comment about the benadryl wafers — these are amazing — use them SL (under tongue) for faster action. Get hives running sometimes — from vibration I think — can keep these in pocket. Packaging would probably go through washer and dryer.

> Nothing like getting a crazy little skin tear ten feet from your front door on
> the way to the car and ending up with an IV in your arm.

Everyone seems to have missed a vital clue here. This infection did NOT happen in the backcountry: it happened in suburbia. It is very likely that the source of the infection was urban dog-poo or something similar.

I would wager that most of the infections people talk about come from an urban environment (and very often from dogs), not from a wilderness area. I've treated quite significant wounds in the mountains with no trouble (and no antibiotics) at all.

Cheers

Americans have grown up with the idea of applying antibiotic ointment to their boo-boos. We have TV commercials telling us that this makes our boo boos heal faster. We have "band aids" containing such ointment. Several antibiotic ointments are available in US grocery stores. Did my MBBS at Sydney and don't remember such an obsession among the public there. Last time I checked, I don't think such antibiotic ointments were available without a doctor's prescription in Australia. Don't think there is much evidence to support the use of topical antibiotics in the absence of infection — no solid evidence that they prevent infection. The real danger may be a perception that such ointments negate the need to adequately clean and care for the wound. If the wound is not clean, the ointment may seal in "germs". Personally, I use bactroban on my boo boos. Placebo effect can be powerful!

Don't really understand the point about infection being acquired in an urban area vs. the backcountry. Most often the culprit is normal skin flora anyway. Once an infxn has manifest, I would think you'd be more interested in treating it than in where you acquired it.

…

Moxifloxacin and the other late generation fluoroquinolones are great antibiotics to have around. Keep a course in my pack. Taken once a day orally, they quickly reach high levels in the body. They have very broad coverage of bacteria affecting the respiratory tract (even the atypical pneumonias and anthrax), GI tract and GU system (chlamydia and gonorrhea as well as the most common causes of UTIs). They do however have an FDA black box WARNING in regard to tendon rupture. Most reported cases have involved the Achilles.

"I would wager that most of the infections people talk about come from an urban environment (and very often from dogs), not from a wilderness area. I've treated quite significant wounds in the mountains with no trouble (and no antibiotics) at all."

Well, good for you – and you missed another point, probably because I didn't state it clearly enough, that I have had years of little scrapes and cuts that did not get infected and did not get antibiotics, both in and out of the wilderness… this was a one time thing out of hundreds of other silly little abrasions. And one time in the wilderness is probably one time I cannot afford, if we're talking about walking 20-50 miles with an infection crawling up my leg/arm. In frontcountry, I'm more likely to take chances – the consequences are less severe.

Remote as the possibility is, dumb stuff happens.

Fairly standard medical advice and some good explanations for the layperson:

http://www.backpackinglight.com/cgi-bin/backpackinglight/forums/thread_display.html?forum_thread_id=11475

BTW, what is this stuff about dogs? Pets? Wild dogs? Never heard dogs implicated in this context. We do exchange skin flora –staph in particular — with our pets and with each other — not that big a deal.

It's when our defenses are breached — in this case our skin is cut that the microbes can more easily overcome our immune defenses. Which is the whole point of irrigating the heck out of wound if possible and if you so desire applying an antibiotic ointment.