From the Guidelines
Antibiotic therapy for decubitus wounds should only be initiated when there are clear signs of infection, not for colonization or prophylaxis. The decision to start antibiotics should be based on clinical judgment, taking into account the presence of signs and symptoms of infection, such as increased redness, swelling, warmth, or purulent discharge. When infection is present, empiric therapy often includes coverage for both gram-positive and gram-negative organisms.
- Common regimens include amoxicillin-clavulanate 875/125 mg twice daily, or trimethoprim-sulfamethoxazole 160/800 mg twice daily plus metronidazole 500 mg three times daily for 7-14 days 1.
- For more severe infections, consider intravenous options like piperacillin-tazobactam 3.375 g every 6 hours or vancomycin 15-20 mg/kg every 12 hours plus ceftazidime 2 g every 8 hours 1. Wound cultures should guide targeted therapy once results are available. Beyond antibiotics, proper wound care is essential, including regular debridement of necrotic tissue, pressure offloading, nutritional support, and moist wound healing techniques. Infection in pressure ulcers often develops due to bacterial invasion of damaged tissue, with common pathogens including Staphylococcus aureus, Pseudomonas aeruginosa, and anaerobes. Treatment should address the underlying factors contributing to ulcer development to prevent recurrence and promote healing.
- The choice of antibiotic regimen should be based on the likely or proven causative pathogen(s) and their antibiotic susceptibilities, as well as patient-related factors such as history of drug allergies and comorbidities 1.
- It is also important to consider the risk of adverse events, potential drug interactions, and the risk of collateral damage to the commensal flora when selecting an antibiotic regimen 1.
From the Research
Antibiotics for Decubitus Wounds
- Decubitus ulcers, also known as pressure ulcers, are localized areas of injury to the skin or underlying tissue, or both 2.
- The use of antimicrobial agents, including antibiotics and antiseptics, is a common practice in the treatment of pressure ulcers 2.
- A review of 12 trials (576 participants) found that the evidence for the use of topical antimicrobial agents in pressure ulcers is limited and of varying quality, ranging from moderate to very low 2.
Types of Antimicrobial Agents
- The included trials assessed the following antimicrobial agents: povidone iodine, cadexomer iodine, gentian violet, lysozyme, silver dressings, honey, pine resin, polyhexanide, silver sulfadiazine, and nitrofurazone with ethoxy-diaminoacridine 2.
- Pine resin salve may heal more pressure ulcers than hydrocolloid, although the evidence is of low quality 2.
- There is no clear difference between cadexomer iodine and standard care, and between honey and a combined antiseptic and antibiotic treatment, although the evidence is of very low quality 2.
Prevention and Treatment
- The most beneficial way to prevent decubitus ulcers is to avoid excessive pressure by encouraging movement, and to minimize risk factors such as malnutrition, poor circulation, and underlying diseases that impair mobility 3.
- A team-focused approach integrating all aspects of care, including pressure relief, infection control, nutrition, and surgery, may improve healing rates 4.
- Antimicrobial wound dressings have emerged as a promising approach for bioburden control and wound healing, and their selection depends on various parameters, including cost, wound type, and local microbial burden 5.