Antibiotics and antiseptics for pressure ulcers

Abstract

The relative effects of systemic and topical antimicrobial treatments on pressure ulcers are not clear. Where differences in wound healing were found, these sometimes favoured the comparator treatment without antimicrobial properties. The trials are small, clinically heterogenous, generally of short duration, and at high or unclear risk of bias. The quality of the evidence ranges from moderate to very low; evidence on all comparisons was subject to some limitations.

Influence of human acute wound fluid on the antibacterial efficacy of different antiseptic polyurethane foam dressings: An in vitro analysis

“…Even though several studies addressed this issue over the past years most concluded that further comprehensive analyses are needed to install clear and individual recommendations for the use of antimicrobial dressings. 10,12,13,17,22 In terms of in vitro test settings experimental designs are often limited to a restricted selection of available dressings or fail to take into account the specific biological wound milieu. 23,24 This generates inconsistent data and complicates translation of results into clinical settings and study designs.…”

“…A wide variety of studies have been conducted in vitro as well as in vivo in the past to investigate the antiseptic efficacy, cytotoxicity, and clinical applicability of such formulations. Nevertheless, the range of available products, especially in case of antiseptic dressings, is wide and the correct choice for the individual setting can be difficult and a general consensus could not be reached so far . Even though several studies showed a benefit of antiseptic formulations regarding prevention and treatment of local wound infection, no overall improvement in healing rates of chronic wounds can be postulated so far .…”

“…Nevertheless, the range of available products, especially in case of antiseptic dressings, is wide and the correct choice for the individual setting can be difficult and a general consensus could not be reached so far . Even though several studies showed a benefit of antiseptic formulations regarding prevention and treatment of local wound infection, no overall improvement in healing rates of chronic wounds can be postulated so far . Also, only a small number of in vitro studies consider the local wound environment (protein concentration, pH, proteolytic enzymes, bacterial species) as crucial influencing factor for antiseptic activity, even though remarkable decrease in efficacy, e.g., under the influence of elevated albumin concentrations or altered pH values, has been described previously .…”

“…12,13 Even though several studies showed a benefit of antiseptic formulations regarding prevention and treatment of local wound infection, [14][15][16] no overall improvement in healing rates of chronic wounds can be postulated so far. 12,13,17 Also, only a small number of in vitro studies consider the local wound environment (protein concentration, pH, proteolytic enzymes, bacterial species) as crucial influencing factor for antiseptic activity, even though remarkable decrease in efficacy, e.g., under the influence of elevated albumin concentrations or altered pH values, has been described previously. 18,19 To account for these influential factors and provide a broad comparison of the performance of available antiseptic dressings under the influence of acute wound fluid (AWF), we conducted the presented in vitro study.…”

Review of the Current Management of Pressure Ulcers

“…Currently, most treatment protocols would recommend the use of intravenous antibiotics when there is evidence of osteomyelitis, but there is actually little evidence for its use. 38,39 Generally, osteomyelitis requires debridement of the infected bone and coverage with a well-perfused flap to allow it to heal. 40 Topical antibiotics have little role in the management of pressure ulcers.…”