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Antibiotics and Antiseptics for Venous Leg Ulcers

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Antibiotics and Antiseptics for Venous Leg Ulcers ● The Cochrane Nursing Nursing Practice Care Field writes exclusively for Nursing Cochrane summary Times readers Leg ulcers This review investigated whether antibiotics and antiseptics were Summary of key evidence more effective than usual care for healing venous leg ulcers and, if Five trials evaluated systemic antibiotics. so, which antibiotic and antiseptic preparations worked the best The remainder evaluated topical prepara- tions: cadexomer iodine; povidone iodine; peroxide-based preparations; ethacridine lactate; mupirocin; and chlorhexidine. For the systemic antibiotics, the only Antibiotics and comparison where there was a statistically significant difference was in favour of levamisole compared with a placebo. How- antiseptics for ever, this trial – as with the other evalua- tions of systemic antibiotics – was small so the observed effect could have occurred by chance. venous leg ulcers For topical preparations, there was some evidence to suggest cadexomer iodine generated higher healing rates than standard care. Review question One study showed a statistically signifi- What are the effects of systemic anti- cant result in favour of cadexomer iodine biotics, topical antibiotics and antiseptics when compared with standard care (not on the healing of venous leg ulcers? involving compression). The intervention regimen used was intensive, involving Nursing implications daily dressing changes, so these findings Chronic venous leg ulcers are slow to heal may not be generalisable to most everyday and provide a perfect medium for bacterial clinical settings. growth. The presence of infection has been When cadexomer iodine was compared shown to delay wound healing, which is with standard care in all patients receiving costly in terms of both nursing interven- compression, the pooled estimate from tion and effects on the patient. two studies for the frequency of complete The two types of treatments for infec- healing at four to six weeks indicated sig- tions are systemic antibiotics and topical nificantly higher healing rates for cadex- preparations. The wounds also require a omer iodine. dressing and bandage to absorb exudate Cadexomer iodine led to better healing and protect the wound bed. Standard care rates than usual care with compression Best practice recommendations usually includes compression bandaging, The review found there is currently no which has been shown to be effective in Control regimens included placebo, an research to support the routine use of sys- healing venous leg ulcers. alternative antibiotic, any other therapy, temic antibiotics to promote the healing of Prescribing guidelines in the UK state standard care or no treatment. leg ulcers. However, the lack of reliable evi- that systemic and topical antibiotics Interventions were delivered in any set- dence means that the discontinuation of should not be used routinely with chronic ting, for example in nursing homes and in any of the agents reviewed cannot be rec- wounds to prevent antibiotic-resistant hospital, to both inpatients and outpa- ommended. strains of bacteria from developing. Anti- tients. Thirty-two comparisons were The effectiveness of topical prepara- bacterial preparations should only be used made. tions such as povidone iodine, peroxide- to treat clinical infection in leg ulcers, not The primary outcome measures were: based preparations, ethacridine lactate, for bacterial colonisation. » Time to complete ulcer healing; mupirocin and chlorhexidine in healing » Proportion of ulcers completely leg ulcers requires further research. There Study characteristics healing during the trial period is some evidence to support the use of This summary is based on a Cochrane sys- (frequency of complete healing); cadexomer iodine. NT tematic review. » Objective measurements of change in Participants had venous leg ulcers; ulcer size; The full review report, including selection was not restricted to those with » Healing rate (for example, a 2mm ulcer references, can be accessed at tinyurl. colonised or infected wounds. The dura- surface area reduction per week). com/coch-antibiotics tion of ulcers was not specified. Secondary outcomes included: A total of 25 prospective randomised » Changes in signs and/or symptoms of Ruth Rojahn is senior lecturer, De Montfort controlled trials were included. The studies clinical infection; University Leicester, England and a evaluated the primary intervention of top- » Changes in bacterial flora; member of the Cochrane Nursing Care ical or systemic antibiotics or antiseptics in » Development of bacterial resistance; Field (CNCF) the treatment of venous leg ulcers. » Ulcer recurrence rates; Trials that considered topical silver and » Adverse effects of treatment; Reference honey-based preparations and wounds » Patient satisfaction; O’Meara S et al (2010) Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of being prepared for skin grafting were » Quality of life; Systematic Reviews; Issue 1 Art No: CD003557. excluded. » Costs. DOI: 10.1002/14651858.CD003557.pub3 www.nursingtimes.net / Vol 108 No 1/2 / Nursing Times 10.01.12 21.
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