Practice development Table 4: Antimicrobial dressings


Antimicro- bial agent


Medicated tulles


Dressing forms


Petrolatum gauze or other non adherent vehicles impregnated with:


n Antibiotics such as framycetin, fucidic acid or bacitracin zinc


Silver dressings


n Antiseptics such as chlorhexidene or iodine Vehicles may include:


n Alginates n Foams n Hydrophilic fibres n Gels n Powders n Impregnated gauze n Combined with oxidised regenerated cellulose/collagen


n Combined with collagen n Coated polyethylene mesh n Impregnated hydrocolloids n Combined with charcoal in a sachet


Iodine Three preparations:


n Iodophor-impregnated gauze n Slow release molecular iodine in cadexomer starch beads


n Povidone iodine-impregnated non- adherent dressing


Comments


n Bacterial resistance may develop to antibiotics


n Antibiotics may cause irritation or allergy n Antiseptic preparations preferred


n Silver may be atomic, oxysalt or ionic form n Broad spectrum of activity against bacteria n Debate about effectiveness of high vs. low release formulations


n Some formulations kill bacteria within dressing


n May reduce inflammation through reduction in matrix metalloproteinases (MMPs)


n May be useful against biofilms in the ‘debride and cover’ strategy


n Charcoal containing preparation may be useful in odour control


n Choose vehicle depending on other wound characteristics


n Broad spectrum activity against gram negative, gram positive, anaerobes, viruses and fungi


n Some evidence of effectiveness of the cadexomer form against biofilms but all may be useful in the ‘debride-and-cover’ strategy


n Cadexomer starch absorbs wound fluid (6x weight)


n Care with large amounts over long periods due to possible thyroid interaction


Polyhex- amethyline biguanide (PHMB) or polyhexa- nide


Hypertonic saline


Honey Multiple preparations:


n Ribbon gauze n Gauze squares n Transfer foam n Backed foam n Non-adherent n Gels


Hypertonic saline in:


n Gauze n Gel


Leptospermum honey in:


n Liquid form n Alginate pads n Hydrocolloids


n Broad spectrum of activity n Bacterial kill largely in dressing n Choose vehicle based on wound characteristics


n Ribbon gauzes are particularly useful for sinuses


n Help to debride necrotic tissue n Help to control bacterial loads n May be painful


n Biocidal effect is multifactorial n May assist with autolytic debridement n Choose formulation based on wound characteristics


26


Wounds International Vol 3 | Issue 3 | ©Wounds International 2012


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