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.