Antibiotics are a valid tool which we can use to improve the chances of success for a piercing. However their use must be moderated with knowledge and diligence.
Choosing an antibiotic
Ointments are recommended for piercings, as they stay soft. Creams, on the other hand, are water-based emulsions and will dry, forming crusts on the jewelry. Thes crusts can be difficult to remove and may injure the interior of a piercing. Body piercers have expressed concern about oinments interfering with the 'toughening-up' process. This is not a valid concern if the antibiotic is used properly. The only way it would interfere would be if it were used continually for months.
The antibiotic ointment preparations available to body piercers are Bacitracin (Baciguent), Polysporin, Neosporin (prescription only in Canada), or their generic equivalents. All of these preparations are suitable for preventing infection in a fresh piercing. None of them are very good at treating infections! The active ingredients tend to remain within the hydrophobic ointment, and do not diffuse into the tissues where the bacteria are.
To treat an infection in a piercing, a water-soluble ointement is best. In our experience, Bactroban (OTC, must be requested from pharmacist) is the most effective. Many doctors prescribe Fucidin (2%) ointment (C&O) for their patients, however the results we have seen would suggest that this is not the proper choice, and is probably due to the presence of gram negative bacteria in the infections. Fucidin is inactive against gram negative bacteria because it will not cross the cell wall; Mupirocin (in Bactroban) is active against gram negative strains.
Bactine is NOT an antibiotic, although many use it, mistakenly believing it is. Any other antibiotic should only be used under the direction of a physician.
Using an antibiotic with a fresh piercing
Using an ointment to prevent infection will improve the chances that the initial healing steps of a piercing will be completed without interference from infections by opportunistic micro-organisms. The more diligent the use, the less likely an infection will occur. Any topical antibiotic should be used for at least a week before stopping, and should not be used for more than two weeks (see CAUTION). If, however, an infection does occur during this period, continuing to use the ointment is like locking the barn door after the horse is stolen. Discontinue use, and look after the infection.
To apply the antibiotic ointment, put a small amount on the jewelry. Use the jewelry is used to work it through to coat the inside of the piercing until the jewelry slides easily. After this is done, any excess antibiotic on the surface should be cleaned away so it does not gather dirt. This should be done each time the piercing is washed to replace the ointment previously applied that has been washed out by the soap.
Using an antibiotic to treat an infected piercing
Be very careful. The following instructions ONLY apply if an infection is present. They do not apply to the use of an antibiotic ointment to prevent infection in a fresh piercing!
If a topical antibiotic is going to be effective, then improvement should be seen within four days. Any topical antibiotic should be used for at least a week before stopping, and should not be used for more than two weeks (see CAUTION). Antibiotics not not kill bacteria on contact. They work slowly, building up to an effective concentration within the tissues, and, usually, starving the bacteria over a period of time. When an infection disappears from the application of an antibiotic, the bacteria may not be very healthy, but they are not dead. Continuing the use of the antibiotic ensures that the bacteria die without regaining their health. (This is why the note on your prescription for pennicillin says "Take until finished". If the antibiotic is stopped prematurely, the bacteria that recover will reinfect the site, and they have likely adapted to survive the next dose. This is how antibiotic resistance arises.)
Antibiotic therapy for an infection should never be relied on as the sole treatment. The factors that precipitated the infection in the first place should be identified and corrected.
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