Antimicrobials

• Iodine is effective against a wide spectrum of organisms and comes in a variety of formulations including solutions, alcoholic tinctures, powder sprays and impregnated dressings. At high concentrations it can be toxic to human cells but bacteria are more sensitive to these effects than human cells such as fibroblasts, and thus it is believed that iodine may be useful for antisepsis without impairing wound healing. At present two types of iodine are available, povidone-iodine and cadexomer-iodine. Povidone-iodine is effective in antibacterial prophylaxis in burn patients but the evidence of its efficacy in other wound types is awaited. Cadexomer-iodine consists of microspheres formed from a three-dimensional lattice of cross-linked starch chains (cadexomers) and has been used with success in the diabetic foot ulcer

• Hypochlorite is most useful in sloughy wounds which are infected and therefore is more appropriate for ulcers in stage 4

• Silver compounds: silver sulfadiazine has been used in antibacterial prophylaxis in wounds and in skin graft donor sites. It is possible that silver may be useful as prophylaxis in diabetic foot ulcers. Recently, silver has been impregnated into dressings. In vitro it is effective in killing Staphylococcus aureus, including MRSA, and Pseudomonas species

• Mupirocin is active against Gram-positive infections including MRSA. To avoid the development of resistance, mupirocin should not be used for longer than 10 days and should not be regarded as a prophylactic.

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