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Topical Antimicrobial Agents 

Topical Antimicrobials Useful in Wounds with Overt and Covert Infection

Agent:

• Cadexomer Iodine
• Silver
• Silver Sulfadiazine
• Polymycin B Sulphate/Bacitracin Zinc
• Mupirocin
• Metrondiazole
• Benzoyl peroxide
• Gentamicin
• Fusidin ointment
• Polymyxin B sulphate/Bacitracin zinc neomycin

Agent	Cadexomer Iodine
S. Aureus	+
MRSA	+
Streptococcus	+
Pseudomonas	+
Anaerobes	+
Comments	Also debrides. Low potential for resistance. Caution with thyroid disease.
Summary	Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Silver
S. Aureus	+
MRSA	+
Streptococcus	+
Pseudomonas	+
Anaerobes	+
Comments	Do not use with saline. Low potential for resistance.
Summary	Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Silver Sulfadiazine
S. Aureus	+
MRSA	+
Streptococcus	+
Pseudomonas	+
Anaerobes	+
Comments	Caution with sulphonamide sensitivity
Summary	Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Polymycin B Sulphate/Bacitracin Zinc
S. Aureus	+
MRSA	+
Streptococcus	+
Pseudomonas	+
Anaerobes	+
Comments	Bacitracin in the ointment is an allergen; the cream formulation contains the less-sensitizing gramicidin.
Summary	Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Mupirocin
S. Aureus
MRSA	+
Streptococcus
Pseudomonas
Anaerobes
Comments	Reserve for MRSA and other resistant Gram+ species
Summary	Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Metrondiazole
S. Aureus
MRSA
Streptococcus
Pseudomonas
Anaerobes	+
Comments	Reserve for anaerobes and odour control. Low or no resistance of anaerobes despite systemic use.
Summary	Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Benzoyl peroxide
S. Aureus	Weak
MRSA	Weak
Streptococcus	Weak
Pseudomonas
Anaerobes	Weak
Comments	Large wounds. Can cause irritation and allergy.
Summary	Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Gentamicin
S. Aureus	+
MRSA
Streptococcus	+
Pseudomonas	+
Anaerobes
Comments	Reserve for oral/IV use-topical use may encourage resistance.
Summary	Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Fusidin ointment
S. Aureus	+
MRSA
Streptococcus	+
Pseudomonas
Anaerobes
Comments	Contains lanolin (except in the cream).
Summary	Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Agent	Polymyxin B sulphate/Bacitracin zinc neomycin
S. Aureus	+
MRSA	+
Streptococcus	+
Pseudomonas	+
Anaerobes	+
Comments	Neomycin component causes allergies, and possibly cross-sensitizes to aminoglycosides.
Summary	Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Source: Sibbald, Orsted et al. (2006). Reprinted with permission.

 

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