Topical Antimicrobial Therapy for Treating Chronic Wounds

Abstract

Various agents have been applied topically to treat infected wounds for millennia, but their proper role remains unclear. Topical therapy affords many potential advantages but also has disadvantages. Opinions differ on which clinical signs define wound infection and on whether quantitative microbiological studies are useful. Clinically infected wounds usually require systemic antibiotic therapy, whereas clinically uninfected wounds that are healing as expected do not require antimicrobials. There is controversy over how to treat poorly healing wounds with "secondary" signs suggesting infection; these may benefit from topical antimicrobial agents. Some evidence supports using topical agents for malodorous or burn wounds. Meta-analyses and systematic reviews suggest there are few proven indications for topical antimicrobials. Use of a newer, relatively nontoxic antiseptic (eg, cadexomer iodine or silver dressings) is preferable to use of topical antibiotics, especially agents that are available for systemic use. We provide clinically relevant information on currently available topical antimicrobial agents.

Silver Nanoparticles as Real Topical Bullets for Wound Healing

“…Iodophors are capable of percutaneous and mucous membrane absorption, and as a result should not be used in pregnant women, newborns, or patients with thyroid disorders. 16,17 In an ex vivo rat model, 10% povidone iodine ointment (Betadine) was shown to have a negative effect on microcirculation. 18 …”

“…14 Antibiotics are often less cytotoxic than are antiseptics; however, they are more likely to lose their efficacy to bacterial resistance. 17 An additional known disadvantage of topical antibiotics is the occurrence of contact allergy. 13 Contact allergy is sometimes secondary to the antibiotic, but it is more often a reaction to preservatives in the delivery vehicle.…”

Comparing two polymeric biguanides: chemical distinction, antiseptic efficacy and cytotoxicity of polyaminopropyl biguanide and polyhexamethylene biguanide

“…Common bacterial strains found in chronic wounds are Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, often residing in biofilms which are increasingly resistant to antimicrobial therapy (Lipsky & Hoey, 2009). Thus, antiseptic wound dressings and agents are becoming increasingly important in the management of chronic and infected wounds (Heyer et al, 2013;Lipsky & Hoey, 2009). …”

Creatinine inhibits bacterial replication

“…4,5 New antibacterial agents with broad-spectrum impact against both Gram-positive 6 and Gram-negative 7 species, as well as against drug-resistant strains such as methicillinresistant Staphylococcus aureus 8 are needed for wound care and to treat topical and dermatological infections. 9 A chance observation in our laboratory revealed that creatinine (CRN; creatinine hydrochloride, CRN-HCl) halted the growth of bacteria on nutrient agar plates. CRN is the naturally occurring breakdown product of creatine phosphate, a high-energy molecule used to store and then donate, a high-energy phosphate to ADP for the synthesis of ATP in metabolism.…”