If a wound has an odor, is it appropriate to start antibiotics?

Antibiotics should not be started solely due to an odor in a wound. First, clarify whether the odor is associated with the drainage or the wound bed. Always remove the dressing and irrigate the wound thoroughly. 

Afterward, assess whether the wound bed still has an odor. Document wound odor only if the wound bed continues to have an odor after irrigation. Next, look at the wound’s progress. If it is showing improvement and no other signs of infection, such as erythema, edema, warmth, crepitus or overt bleeding, then the wound is not infected and antibiotics are unnecessary.

If the wound has an odor and is not showing progress and/or has other signs of infection, then infection is possible.

If you suspect infection, don’t immediately think antibiotic. First confirm the infection. If there is none, you can avoid unnecessary antibiotic use. If there is one, choose a targeted antibiotic instead of a broad-spectrum drug. This will ensure appropriate antibiotic use and prevent resistance or complications such as Clostridium difficile.

The gold standard is to obtain a tissue biopsy. It will identify organisms invading the wound rather than those contaminating the wound surface. Surface swabs will reveal only the colonizing organism and may not reflect deeper tissue infection.

If the wound is in need of debridement, this is an ideal time to obtain the tissue biopsy. If a tissue biopsy is not feasible, then obtain a swab using the Levine method. Ensure you culture only viable tissue and not the drainage, eschar or slough. 

If antibiotics were prescribed while awaiting the culture results, be sure to closely watch the culture results to see whether the antibiotics need to be adjusted or may be discontinued. 

Please send your wound treatment-related questions to “Ask the Expert” at [email protected]