What is the treatment for an infected wound?

From the Guidelines

The treatment for an infected wound involves selecting an empirical antibiotic regimen based on the severity of the infection and the likely etiologic agent(s), and providing optimal wound care, including proper wound cleansing, debridement of any callus and necrotic tissue, and off-loading of pressure 1.

Key Considerations

• Antibiotic therapy is necessary for virtually all infected wounds, but it is often insufficient without appropriate wound care 1.
• The initial antibiotic regimen must usually be selected empirically, and it may be modified later on the basis of availability of additional clinical and microbiological information 1.
• Severe infections require parenteral therapy, at least initially, while mild and most moderate infections can be treated with oral antibiotics that are highly bioavailable 1.
• The duration of antibiotic therapy should be based on the severity of the infection and the clinical response to treatment, and should be continued until there is evidence that the infection has resolved, but not necessarily until the wound has healed 1.

Wound Care

• Proper wound care is essential for healing and includes proper wound cleansing, debridement of any callus and necrotic tissue, and off-loading of pressure 1.
• The choice of a dressing should be based mainly on whether the wound is exudative or dry 1.

Adjunctive Treatments

• There is limited evidence to support the use of topical antimicrobials for infected or uninfected diabetic foot wounds 1.
• Studies on granulocyte colony-stimulating factors have reported mixed results on various outcomes of diabetic foot infection 1.

Recent Guidelines

• The 2024 American Heart Association and American Red Cross guidelines for first aid recommend that wound infection often requires treatment with antibiotics, which must be prescribed by a health care professional 1.

From the FDA Drug Label

1. 3 Skin and Skin Structure Infections Cephalexin capsules are indicated for the treatment of skin and skin structure infections caused by susceptible isolates of the following Gram-positive bacteria: Staphylococcus aureusand Streptococcus pyogenes.

The treatment for an infected wound may include cephalexin capsules if the infection is caused by susceptible isolates of Gram-positive bacteria such as Staphylococcus aureus and Streptococcus pyogenes 2.

• The usual dose of oral cephalexin capsules is 250 mg every 6 hours, but a dose of 500 mg every 12 hours may be administered.
• Treatment is administered for 7 to 14 days.
• For more severe infections larger doses of oral cephalexin capsules may be needed, up to 4 grams daily in two to four equally divided doses.

From the Research

Treatment for Infected Wounds

The treatment for infected wounds involves a combination of approaches to prevent further infection, promote healing, and manage symptoms. Some key considerations include:

• Wound cleansing and debridement to remove devitalized tissue and foreign bodies 3
• Use of antimicrobial agents, such as topical antibiotics, to control bacterial growth 4, 3, 5
• Application of moisture-retentive dressings to promote a conducive environment for healing 3
• Management of inflammation, which can be achieved through various therapeutic strategies 3, 6
• Recognition of the type of wound infection (acute or chronic) to guide appropriate therapy 6

Antimicrobial Agents and Dressings

Antimicrobial agents loaded into wound dressings have been shown to be effective in reducing wound colonization and improving the healing process 4. These agents can include:

• Antibiotics 4, 5
• Nanoparticles 4
• Cationic organic agents 4, 3
• Plant-derived natural compounds, such as essential oils and polyphenols 4, 3
• Honey 3

Importance of Judicious Antibiotic Use

The use of antibiotics in wound management should be judicious and responsible, as overuse can contribute to antibiotic resistance 6, 5. Systemic antibiotic therapy may be necessary for acute wound infections, but its use in chronic wound infections should be carefully considered 6. Topical antibiotics can be effective in preventing infection and promoting healing in uncomplicated wounds 5.