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.
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.
- 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.
- Electrical stimulation is recommended as an adjunctive therapy to accelerate wound healing, with moderate-quality evidence supporting its use 1.
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 2
- Topical agents: such as collagenase ointment, foam dressings, and polyvinylpyrrolidone plus zinc oxide 2
- Negative pressure wound therapy (NPWT) 3, 4
- Topical phenytoin 5
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 2
- Hydrogel dressings may be as effective as other dressings, but the evidence is of low certainty 6
- NPWT may speed up the reduction of pressure ulcer size and severity, but the evidence is of very low certainty 3, 4
- Topical phenytoin may not improve ulcer healing compared to hydrocolloid dressings, but the evidence is of low quality 5
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 2
- NPWT may be as effective as other treatments, but the evidence is limited and of low quality 3, 4
- Topical phenytoin may be as effective as simple dressings, but the evidence is of very low quality 5
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 2
- More research is needed to determine the effectiveness of NPWT for treating pressure ulcers 3, 4
- Further trials are needed to examine the effects of topical phenytoin for treating pressure ulcers 5