Antimicrobials

Antimicrobials are agents that have broad-spectrum activity and can kill (biocidal) or inhibit (biostatic) microorganisms such as Gram-Positive, Gram-Negative, aerobic and anaerobic bacteria, yeast and spores that can be commonly found within wound bioburden (Wolcott et al., 2008).

Topical antimicrobials play a role in treating the wound when it is likely to be clinically infected.

Topical antimicrobial treatment should consider:

• Broad-spectrum antimicrobial action and/or known efficacy for confirmed microorganisms
• Efficacy in achieving clinical goals of care of the individual
• No or low cytotoxicity, irritancy and allergenicity to wound tissue and the periwound skin
• Fast and long-acting activity
• No or low propensity to select bacterial resistance
• Local availability and guidance
• Prevention in individuals at wound management at a higher risk of developing an infection
• Treatment of a local infection
• For a non-healing wound where other causes have been excluded
• Treatment of overt infection, consider using in conjunction with systemic antibiotics
• Treatment of spreading infection in conjunction with systemic antibiotics
• Fast and long-acting activity and no or low propensity to select bacterial resistance
• Contraindications and known allergies taken into consideration
• A clear treatment and management plan with continual reassessment

(Vowden, 2011; Wounds UK, 2020; IWII, 2022)

Treatment with antimicrobial dressings should be monitored closely. Any delay in the wound responding to the antimicrobial should be noted, and a reassessment of the wound undertaken, potentially incorporating further diagnostics, such as a wound swab, to identify alternative treatment options.