What medications are used to treat pressure sores?

Medications for Pressure Sore Treatment

Medications play a limited but specific role in pressure sore management, with protein/amino acid supplementation being the primary pharmacologic intervention recommended, while topical agents like platelet-derived growth factor (PDGF) and systemic antibiotics are reserved for specific clinical scenarios.

Nutritional Pharmacotherapy (Primary Medication Intervention)

Protein or amino acid supplementation is the cornerstone medication intervention for pressure ulcers, with moderate-quality evidence showing improved wound healing rates. 1

• Provide protein or amino acid supplementation specifically to reduce wound size, particularly in nutritionally deficient patients 2, 3, 4
• This intervention improves the rate of wound healing based on moderate-quality evidence 1
• Vitamin C supplementation should NOT be used, as low-quality evidence shows no benefit compared to placebo 1, 3, 4
• Do not routinely supplement with other vitamins or trace elements unless documented deficiency exists 3

Topical Biological Agents

Platelet-derived growth factor (PDGF/becaplermin) improves ulcer healing for more severe ulcers (>7 cm), though evidence remains low-quality. 1

• PDGF improved wound healing compared with placebo specifically for larger, more severe ulcers 1
• Evidence is insufficient for other bioengineered skin products and growth factors 2
• Topical collagen showed mixed findings with low-quality evidence 1

Systemic Medications

Anabolic Steroids (Limited Use)

Oxandrolone showed mixed results and carries significant hepatotoxicity risk, making it a poor choice for routine use. 1

• Oxandrolone resulted in elevated liver enzyme levels in 32.4% versus 2.9% with placebo (P < 0.001) 1
• No difference in withdrawals due to adverse events (19% vs 18%) 1
• Evidence did not show clear benefit for wound healing 1

Antibiotic Therapy (Infection Management Only)

Systemic antibiotics are indicated ONLY when infection is present, not for routine pressure ulcer treatment. 2, 3

• For infected pressure ulcers, use broad-spectrum antibiotics covering Gram-positive and Gram-negative facultative organisms plus anaerobes, as these infections are typically polymicrobial 2
• Use systemic antibiotics for deeper or more severe infections with signs of cellulitis 2, 5
• Consider topical antimicrobials (iodine preparations, medical-grade honey, silver-containing dressings) for superficial infections 3
• Do NOT culture wounds without clinical signs of infection, as this leads to inappropriate antibiotic use 3

Topical Antimicrobials (Cautious Use)

Antimicrobial dressings should not be used as the sole intervention to accelerate healing. 4

• Apply topical antimicrobials judiciously when infection is present 3
• Do NOT use povidone iodine routinely, as it may impair healing compared to non-antimicrobial dressings 3
• Metronidazole is useful specifically for malodorous sores 5

Medications to AVOID

Dextranomer paste is inferior to other wound dressings and should not be used. 1, 3

• Low-quality evidence showed dextranomer paste was inferior to other dressings for reducing wound size 1

Critical Clinical Pitfalls

• Do NOT use medications as monotherapy—pressure offloading, debridement, and appropriate dressings remain the foundation of treatment 2, 3
• Do NOT prescribe antibiotics prophylactically or without clear signs of infection (increasing pain, erythema, warmth, purulent drainage) 2, 3
• Do NOT rely on vitamin supplementation for wound healing unless specific deficiency is documented 3, 4
• Assess for osteomyelitis with probe-to-bone test and imaging if positive before initiating antibiotic therapy 3