Antibiotics and antiseptics for venous leg ulcers

O’Meara, Susan; Al‐Kurdi, Deyaa; Ologun, Yemisi; Ovington, Liza G.; James, Marrissa Martyn-St; Richardson, Rachel

doi:10.1002/14651858.cd003557.pub4

Cited by 18 publications

(25 citation statements)

References 106 publications

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“…In terms of systemic antimicrobial agents, 199 there is some evidence that levamisole may be effective for healing venous leg ulcers; this treatment is normally used to treat roundworm infection and has restricted availability. In terms of topical antimicrobials for venous leg ulcers, 199 cadexomer iodine may heal more wounds than standard care. There was no evidence for a difference between honey-and silver-based products compared with non-antimicrobial interventions.…”

Section: Discussionmentioning

confidence: 99%

“…These included questions relating to choice of dressings for diabetic foot ulcers and venous leg ulcers. The following new reviews and review updates were conducted: l a series of Cochrane systematic reviews on dressings for diabetic foot ulcers [192][193][194][195] l a systematic review and mixed-treatment comparison meta-analysis of all dressing types in patients with diabetic foot ulcers 196 l two Cochrane reviews of non-antimicrobial dressings in venous leg ulcers 197,198 and a substantive update of a Cochrane review on antimicrobial interventions for venous leg ulcers 199 l a scoping review of silver-impregnated dressings used with venous leg ulcers (see Chapter 4, Discussion) l a substantive update of a Cochrane review on nutritional interventions for preventing and treating pressure ulcers 200 (note: this publication is not claimed as an output of the programme per se; however, the high priority of the topic stimulated us to strongly encourage the Cochrane reviewers to update the review and we expedited the editorial process to facilitate this).…”

Section: Actions Taken Following Identification Of Relevant Literaturementioning

confidence: 99%

“…Antibiotics and antiseptics for venous leg ulcers 199 To determine the effects of systemic antibiotics and topical antibiotics and antiseptics on the healing of venous ulcers Update Topical agents or dressings for pain in venous leg ulcers 245 To determine the effects of topical agents or dressings for pain in venous leg ulcers Update…”

Section: Updatementioning

confidence: 99%

“…As a result of this, several topics were pinpointed as suitable candidates for Cochrane reviews, either as new reviews or updates of existing reviews. Eleven reviews were undertaken overall on interventions for diabetic foot ulcers (five reviews [192][193][194][195]244 ), venous leg ulcers (five reviews 184,[197][198][199]245 ) and surgical wounds (one review 246 ). All used standard Cochrane systematic review methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions 163 and all were carried out under the auspices of the Cochrane Wounds Group (see http://wounds.cochrane.org/).…”

Section: Introductionmentioning

confidence: 99%

“…l Antibiotics and antiseptics for venous leg ulcers. 199 l Topical agents or dressings for pain in venous leg ulcers. 245 Review of interventions used with surgical wounds l Pre-operative skin antiseptics for preventing surgical wound infections after clean surgery.…”

Section: Introductionmentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%