From the Guidelines
For bed sores (pressure ulcers), hydrocolloid dressings like DuoDERM are recommended for non-infected sores, as they have been shown to reduce wound size compared to gauze dressings 1, 2, 3.
Key Considerations
- The best ointment for pressure ulcer treatment depends on the stage of the wound.
- Silver sulfadiazine cream (Silvadene) is often recommended for infected wounds.
- For early-stage bed sores, zinc oxide ointments provide good protection.
- Bacitracin or Neosporin can help prevent infection in minor wounds.
- Apply these medications after gently cleaning the area with saline solution and patting dry.
- Change dressings 1-3 times daily depending on drainage.
Additional Recommendations
- Beyond topical treatment, pressure relief is crucial - reposition the patient every 2 hours, use specialized mattresses or cushions, and ensure adequate nutrition with protein and vitamin C to support healing.
- Bed sores develop when prolonged pressure cuts off blood supply to tissues, causing cell death, so prevention through regular position changes and proper skin care is as important as treatment.
- Consult a healthcare provider for severe or worsening wounds, as they may require prescription treatments or debridement.
Evidence Summary
- The American College of Physicians (ACP) recommends using protein or amino acid supplementation in patients with pressure ulcers to reduce wound size, although the evidence is of low quality 1, 2.
- The ACP also recommends using hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size, with low-quality evidence supporting this recommendation 1, 2.
- Electrical stimulation is recommended as an adjunctive therapy to accelerate wound healing, with moderate-quality evidence supporting its use 3.
From the Research
Pressure Ulcer Treatment Options
The following are some of the treatment options for pressure ulcers:
- Dressings: including alginate, hydrocolloid, and protease-modulating dressings 4
- Topical agents: such as collagenase ointment, foam dressings, and polyvinylpyrrolidone plus zinc oxide 4
- Negative pressure wound therapy (NPWT) 5, 6
- Topical phenytoin 7
Effectiveness of Treatment Options
The effectiveness of these treatment options is uncertain due to the limited and low-quality evidence available:
- Protease-modulating dressings may increase the probability of pressure ulcer healing compared to saline gauze, but the evidence is of moderate certainty 4
- Hydrogel dressings may be as effective as other dressings, but the evidence is of low certainty 8
- NPWT may speed up the reduction of pressure ulcer size and severity, but the evidence is of very low certainty 5, 6
- Topical phenytoin may not improve ulcer healing compared to hydrocolloid dressings, but the evidence is of low quality 7
Comparison of Treatment Options
Comparing the different treatment options is challenging due to the limited evidence available:
- There is no clear evidence to suggest that one dressing or topical agent is more effective than another 4
- NPWT may be as effective as other treatments, but the evidence is limited and of low quality 5, 6
- Topical phenytoin may be as effective as simple dressings, but the evidence is of very low quality 7
Need for Further Research
Further research is needed to determine the effectiveness of different treatment options for pressure ulcers:
- Large, well-designed trials are needed to compare the effectiveness of different dressings and topical agents 4
- More research is needed to determine the effectiveness of NPWT for treating pressure ulcers 5, 6
- Further trials are needed to examine the effects of topical phenytoin for treating pressure ulcers 7