Antibiotics have a vital role in wound management, both in the treatment and prophylaxis of infection. Depending on the circumstances, antibiotics may be administered systematically, topically, or via a combination of both routes.(1,2)
Administering antibiotics topically generally allows a lower dose to be used, as the active component comes into direct contact with the microorganism and is not lost through adsorption or distribution. Topical antibiotics are indicated in the case of a diagnosed or suspected significant bacterial infection or when a high risk of infection is identified. However, routine use of topical antibiotics is strongly discouraged as this may lead to the development of resistant bacteria.(1)
Systemic antibiotics tend to be prescribed for sepsis or signs of advancing infection, and may be administered orally or intravenously. Compliance with systemic antibiotics tends to be higher than topical treatments, but systemic treatment can be associated with more frequent and/or severe adverse reactions as well as higher costs.(1,2)
If a topical antibiotic is considered most appropriate it is usually administered as a lotion, ointment, or cream. In general, a lotion or paste is most suited to wet or weeping skin and wounds, while a greasy ointment should be used for dry, cracked skin. Creams may be used, to some extent, on either a wet or dry surface, and are generally easier to apply. A number of antimicrobial dressings are also available on the market, although these can be costly and require the dressing to remain in contact with the wound bed at all times for maximum effectiveness. Antimicrobial dressings which have attracted considerable attention to date are those impregnated with nano-silver which acts as a broad-spectrum antibacterial and shows little sign of resistance.(1,2)
Over the coming weeks we will look at a number of antibiotic options in wound management, both in the treatment and prevention of infection. An entire module within our wound certification training course is devoted to the problem of infection in wound care and the role of antibiotics in this area.
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- Bates-Jensen BM, Ovington LG. Management of exudate and infection. In: Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
- Landis SJ. Chronic Wound Infection and Antimicrobial Use Adv Skin & Wound Care 2008; 21: 531–540