Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review.
Journal
Advances in skin & wound care
ISSN: 1538-8654
Titre abrégé: Adv Skin Wound Care
Pays: United States
ID NLM: 100911021
Informations de publication
Date de publication:
03 Oct 2024
03 Oct 2024
Historique:
medline:
2
10
2024
pubmed:
2
10
2024
entrez:
2
10
2024
Statut:
aheadofprint
Résumé
Chronic wounds place a heavy burden on healthcare systems and markedly reduce the ability of patients to engage in activities of daily living. One major factor contributing to impaired wound healing is bacterial bioburden. With the rise in antibiotic resistance and the slowdown in antibiotic development pipelines, alternative antimicrobial strategies are important. The objective of this systematic review is to determine the topical antiseptic therapeutic index values for bacterial species commonly isolated from chronic wounds. The therapeutic index is a ratio of the lowest concentration that causes mammalian cell cytotoxicity over the minimum bactericidal concentration. Higher values indicate greater safety and potential clinical benefit. A systematic literature search was performed in Medline and Embase, resulting in the inclusion of 37 articles that reported on the minimum bactericidal concentration in bacterial species commonly isolated from chronic wounds and their cytotoxicity concentrations in mammalian cells. The therapeutic indices for the topical antiseptics included in this study were generally low, with most ranging between 0.5-3.0. The highest therapeutic index values for Escherichia coli (5.49), Staphylococcus aureus (6.31) and Pseudomonas aeruginosa (8.81) were achieved by hypochlorous acid, whereas the highest therapeutic index values for methicillin resistant S aureus (12.1) was achieved by polyhexamethylenebiguanide. Antibiotic stewardship principles may need to be applied to topical antiseptics due to some isolated evidence of topical antiseptic resistance and cross-resistance to antibiotics. The choice of antiseptic should not be made solely based on therapeutic index values, but individualized to the patient, with consideration for the wound healing condition that may include covert infection.
Identifiants
pubmed: 39355996
doi: 10.1097/ASW.0000000000000233
pii: 00129334-990000000-00053
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Dr Sibbald has received honoraria from Perfuse, Quart Medical, Novartis, Medexus Pharmaceuticals Canada along with Ontario Gov’t (Project ECHO Ontario Skin & Wound- Ministry of Health and Micro-credentials – through Ministry of Colleges and Universities and Sault College all unrelated to this work. The remaining authors have no conflicts of interest to disclose.
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