Antimicrobial Ointments for Gastrostomy Tube Site Infection Prevention
For gastrostomy tube site care, antimicrobial ointments or dressings containing silver, iodine, or polyhexamethylene biguanide should be applied topically to the entry site and surrounding tissue when infection is suspected or diagnosed. 1
Specific Antimicrobial Agents
Recommended Topical Antimicrobial Options
Silver-based dressings (foams, hydrocolloids, or alginates) provide sustained-release antimicrobial activity directly to the gastrostomy site 1
Iodine-containing dressings deliver antimicrobial coverage and are available in multiple formulations 1
Polyhexamethylene biguanide (PHMB) dressings offer broad-spectrum antimicrobial activity 1
Silver sulfadiazine is bactericidal for many gram-negative and gram-positive bacteria as well as yeast, acting on the cell membrane and cell wall 2
Application Strategy
Clean the affected skin at least once daily using an antimicrobial cleanser before applying topical agents 1, 3
Apply the antimicrobial agent under the fixation device or as a foam/silver dressing over the affected area 1
Change dressings only when there is evidence of significant exudate, but at minimum weekly 1
Critical Caveat: Avoid Topical Antibiotics
Topical antibiotics (such as triple-antibiotic ointment containing neomycin, polymyxin B, and bacitracin) should NOT be used for gastrostomy site infections, as they promote antimicrobial resistance. 1, 4, 5 While triple-antibiotic ointment is effective for minor skin trauma 6, the ESPEN guidelines explicitly state that topical antibiotics should be avoided in gastrostomy care 1.
Important Safety Considerations
Check for allergies to silver, iodine, or polyhexamethylene biguanide before application 1, 4
Silver dressings cannot be worn during MRI procedures and must be removed beforehand 1, 4
If topical antimicrobial treatment fails to resolve the infection, add systemic broad-spectrum antibiotics 1, 3
Adjunctive Skin Protection
Zinc oxide-based barrier creams, pastes, or films protect surrounding skin from gastric content leakage but are not antimicrobial agents themselves 1, 4
Foam dressings are preferred over gauze as they lift drainage away from skin, reducing maceration 1, 4
When to Escalate Treatment
If infection persists despite topical antimicrobial treatment combined with systemic broad-spectrum antibiotics, the tube should be removed 1
Stoma tract disruption, persistent peristomal infection, severe skin excoriation, or fungal infection (particularly with silicone tubes) warrant tube removal and replacement 1