Antibiotics, Antiseptics, and Cutaneous Ulcers


Contact Dermatitis Systemic Antibiotic Topical Antibiotic Cutaneous Ulcer Silver Sulfadiazine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dagher FJ, Alongi SV, Smith A: Bacterial studies of leg ulcers. Angiology 1978; 29:641–653PubMedGoogle Scholar
  2. 2.
    Friedman SA, Gladstone JL: The bacterial flora of peripheral vascular ulcers. Arch Dermatol 1969; 100:29–32CrossRefPubMedGoogle Scholar
  3. 3.
    Eriksson G, Eklund AE, Kallings LO: The clinical significance of bacterial growth in venous leg ulcers. Scand J Infect Dis 1984; 16:175–180PubMedGoogle Scholar
  4. 4.
    Robson MC: Wound infection. A failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am 1997; 77:637–650CrossRefPubMedGoogle Scholar
  5. 5.
    Robson MC, Stenberg BD, Heggers JP: Wound healing alterations caused by infection. Clin Plast Surg 1990; 17:485–492Google Scholar
  6. 6.
    Reed BR, Clark RA: Cutaneous tissue repair: Practical implications of current knowledge. 2. J Am Acad Dermatol 1985; 13:919–941PubMedGoogle Scholar
  7. 7.
    Kirsner RS, Martin LK, Drosou A: Wound microbiology and the use of antibacterial agents. In: Rovee D, Maibach HI (eds) The Epidermis in Wound Healing, 1st edn. Boca Raton: CRC Press. 2004; pp 153–182Google Scholar
  8. 8.
    Madsen SM, Westh H, Danielsen L, et al: Bacterial colonization and healing of venous leg ulcers. APMIS 1996; 104:895–899PubMedGoogle Scholar
  9. 9.
    Halbert AR, Stacey MC, Rohr JB, et al: The effect of bacterial colonization on venous leg ulcer healing. Australas J Dermatol 1992; 33:75–80PubMedGoogle Scholar
  10. 10.
    Browne A, Dow G, Sibbald RG: Infected wounds; definitions and controversies. In: Falanga V (ed) Cutaneous Wound Healing, 1st edn. London: Martin Dunitz. 2001; pp 203–219Google Scholar
  11. 11.
    Osterholm MT, Hedberg CW, Moore KA: Epidemiologic principles. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th edn. Philadelphia: Churchill Livingstone. 2000; pp 156–167Google Scholar
  12. 12.
    Murray PR, Rosenthal KS, Koyabayashi GS, Pfaller MA: Mechanisms of bacterial pathogenesis. In: Medical Microbiology, 3rd edn. St. Louis: Mosby. 1998; pp 152–159Google Scholar
  13. 13.
    Robson MC, Heggers JP: Bacterial quantification of open wounds. Mil Med 1969; 134:19–24PubMedGoogle Scholar
  14. 14.
    Harkess N: Bacteriology. In: McCulloch JM, Kloth LC, Feedar JA (eds) Wound Healing: Alternatives in Management, 2nd edn. Philadelphia: F.A. Davis Company. 1995; pp 60–86Google Scholar
  15. 15.
    Irvin TT: Collagen metabolism in infected colonic anastomoses. Surg Gynecol Obstet 1976;143:220–224PubMedGoogle Scholar
  16. 16.
    Baroni A, Gorga F, Baldi A, et al: Histopathological features and modulation of type IV collagen expression induced by Pseudomonas aeruginosa lipopolysaccharide (LPS) and porins on mouse skin. Histol Histopathol 2001; 16:685–692PubMedGoogle Scholar
  17. 17.
    Nagano T, Hao JL, Nakamura M, et al: Stimulatory effect of pseudomonal elastase on collagen gedradation by cultured keratocytes. Invest Ophthalmol Vis Sci 2001; 42:1247–1253PubMedGoogle Scholar
  18. 18.
    Stephens P, Wall IB, Wilson MJ, et al: Anaerobic cocci populating the deep tissues of chronic wounds impair cellular wound healing responses in vitro. Br J Dermatol 2003; 148:456–466CrossRefPubMedGoogle Scholar
  19. 19.
    Chambers HF: Antimicrobial agents: General considerations. In: Hardman JG, Limbird LE, Gilman AG (eds) Goodman & Gilman's. The Pharmacological Basis of Therapeutics, 10th edn. New York: McGraw-Hill. 2001; pp 1143–1170Google Scholar
  20. 20.
    Brooks GF, Butel JS, Morse SA: Antimicrobial chemotherapy. In: Jawetz, Melnick & Adelberg's Medical Microbiology. 21st edn. Stamford, Conn.: Appleton & Lange. 2001; pp 144–175Google Scholar
  21. 21.
    Tunkel AR: Topical antibacterials. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 5th edn. Philadelphia: Churchill Livingstone. 2000; pp 428–435Google Scholar
  22. 22.
    Cavanagh PR, Buse JB, Frykberg RG, et al: Consensus development conference on diabetic foot wound care. Diabetes Care 1999; 22:1354–1360PubMedGoogle Scholar
  23. 23.
    Parish LC, Witkowski JA: The infected decubitus ulcer. Int J Dermatol 1989; 28:643–647PubMedGoogle Scholar
  24. 24.
    Niedner R, Schopf E: Wound infections and antibacterial therapy. In: Westerhof W (ed) Leg Ulcers: Diagnosis and Treatment. Amsterdam: Elsevier. 1993; pp 293–303Google Scholar
  25. 25.
    Lipsky BA, Berendt AR: Principles and practice of antibiotic therapy of diabetic foot infections. Diabet Met Res Rev 2000; 16[Suppl 1]:S42–S46Google Scholar
  26. 26.
    Robson MC: Wound Infection: a failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am 1997; 77:637–650CrossRefPubMedGoogle Scholar
  27. 27.
    Tsao H, Swartz MN, Weinberg AN, Johnson RA: Soft tissue infections; erysipelas, cellulitis and gangrenous cellulitis. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI and Fitzpatrick TB (eds) Fitzpatrick's Dermatology in General Medicine, 5th edn. New York: McGraw-Hill. 1999; pp 2213–2231Google Scholar
  28. 28.
    Swartz MN: Cellulitis and subcutaneous tissue infections. Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 5th edn. Philadelphia: Churchill Livingstone. 2000; pp 1037–1057Google Scholar
  29. 29.
    Cutting KF, Harding KG: Criteria to identify wound infection. J Wound Care 1994; 3:198–201Google Scholar
  30. 30.
    O'Meara SM, Cullum NA, Majid M, et al: Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 2000; 88:4–21CrossRefGoogle Scholar
  31. 31.
    Filius G, Gyssens IC: Impact of increasing antimicrobial resistance on wound management. Am J Clin Dermatol 2002; 3:1–7PubMedGoogle Scholar
  32. 32.
    Alinovi A, Bassissi P, Pini M: Systemic administration of antibiotics in the management of venous ulcers. A randomized clinical trial. J Am Acad Dermatol 1986; 15:186–191PubMedGoogle Scholar
  33. 33.
    Huovinen S, Kotilainen P, Jarvinen H, et al: Comparison of ciprofloxacin or trimethoprim therapy for venous leg ulcers: results of a pilot study. J Am Acad Dermatol 1994; 31:279–281PubMedGoogle Scholar
  34. 34.
    Chantelau E, Tanudjaja T, Altenhofer F, et al: Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med 1996; 13:156–159CrossRefGoogle Scholar
  35. 35.
    Valtonen V, Karppinen L, Kariniemi AL: A comparative study of ciprofloxacin and conventional therapy in the treatment of patients with chronic lower leg ulcers infected with Pseudomonas aeruginosa or other gram-negative rods. Scand J Infect Dis 1989; 60[Suppl]:79–83Google Scholar
  36. 36.
    Morias J, Peremans W, Campaert H, et al: Levamisole tratment in ulcus cruris. A double-blind placebo-controlled study. Arzneimittelforschung 1979; 29:1050–1052PubMedGoogle Scholar
  37. 37.
    Hutchinson JJ, McGuckin M: Occlusive dressings: a microbiologic and clinical review. Am J Infect Control 1990; 18:257–268CrossRefPubMedGoogle Scholar
  38. 38.
    Thomson PD, Smith DJ Jr: What is infection? Am J Surg 1994; 167[Suppl]:7S–11SCrossRefPubMedGoogle Scholar
  39. 39.
    Friedman SJ, Su WP: Management of leg ulcers with hydrocolloid occlusive dressing. Arch Dermato 1984; 120:1329–1336CrossRefPubMedGoogle Scholar
  40. 40.
    Gilchrist B, Reed C: The bacteriology of chronic venous ulcers treated with occlusive hydrocolloid dressing. Br J Dermatol 1989; 121:337–344PubMedGoogle Scholar
  41. 41.
    Opal SM, Mayer KH, Medeiros AA: Mechanisms of bacterial antibiotic resistance. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th edn. Philadelphia: Churchill Livingstone. 2000; pp 236–253Google Scholar
  42. 42.
    Wenzel RP, Edmond MB: Managing antibiotic resistance. N Engl J Med 2000; 343:1961–1963CrossRefPubMedGoogle Scholar
  43. 43.
    Gold HS, Meollering RC Jr: Antimicrobial-drug resistance. N Engl J Med 1996; 335:1445–1453CrossRefPubMedGoogle Scholar
  44. 44.
    Hart CA: Antibiotic resistance: an increasing problem? Br Med J 1998; 316:1255–1256Google Scholar
  45. 45.
    Colsky AS, Kirsner RS, Kerdel FA: Analysis of antibiotic susceptibilities of skin wound flora in hospitalized dermatology patients. The crisis of antibiotic resistance has come to the surface. Arch Dermatol 1998; 134:1006–1009CrossRefPubMedGoogle Scholar
  46. 46.
    Gould IM: A review of the role of the antibiotic policies in the control of antibiotic resistance. J Antimicrob Chemother 1999; 43:459–465CrossRefPubMedGoogle Scholar
  47. 47.
    Roghmann MC, Siddiqui A, Plaisance K, et al: MRSA colonization and the risk of MRSA bacteremia in hospitalized patients with chronic ulcers. J Hosp Inf 2001; 47:98–103CrossRefGoogle Scholar
  48. 48.
    Skog E, Arnesjo B, Troeng T, et al: A randomized trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers. Br J Dermatol 1983; 109:77–83Google Scholar
  49. 49.
    Lookingbill DP, Miller SH, Knowles RC: Bacteriology of chronic leg ulcers. Arch Dermatol 1978; 114:1765–1768CrossRefPubMedGoogle Scholar
  50. 50.
    Wall IB, Davies CE, Hill KE, et al: Potential role of anaerobic cocci in impaired human wound healing. Wound Repair Regen 2002; 10:346–353CrossRefPubMedGoogle Scholar
  51. 51.
    Wyatt TD, Ferguson WP, Wilson TS, et al: Gentamycin resistant Staphylococcus aureus associated with the use of topical gentamicin. J Antimicrob Chemother 1977; 3:213–217PubMedGoogle Scholar
  52. 52.
    Rahman M, Noble WC, Cookson B: Mupirocin-resistant Staphylococcus aureus (letter). Lancet 1987; 2:387CrossRefPubMedGoogle Scholar
  53. 53.
    Eriksson G: Local treatment of venous leg ulcers. Acta Chir Scand 1988; 544[Suppl]:47–52Google Scholar
  54. 54.
    Leyden JJ, Kligman AM: Rationale for topical antibiotics. Cutis 1978; 22:515–520, 522–528PubMedGoogle Scholar
  55. 55.
    Leyden JJ, Sulzberger MB: Topical antibiotics and minor skin trauma. Am Fam Phys 1981; 23:121–125Google Scholar
  56. 56.
    Langford JH, Benrimoj SI: Clinical rationale for topical antimicrobial preparations. J Antimicrob Chemother 1996; 37:399–402PubMedGoogle Scholar
  57. 57.
    Fleming A: The action of chemical and physiological antiseptics in a septic wound. Br J Surg 1919; 7:99–129Google Scholar
  58. 58.
    Brennan SS, Leaper DJ: The effect of antiseptics on the healing wound: a study using the rabbit ear chamber. Br J Surg 1985; 72:780–782PubMedGoogle Scholar
  59. 59.
    Lineaweaver W, McMorris S, Soucy D, et al: Cellular and bacterial toxicities of topical antimicrobials. Plst Reconst Surg 1985; 75:394–396Google Scholar
  60. 60.
    Damour O, Hua SZ, Lasne F, et al: Cytotoxicity evaluation of antiseptics and antibiotics on cultured human fibroblasts and keratinocytes. Burns 1992; 18:479–485CrossRefPubMedGoogle Scholar
  61. 61.
    Smoot EC 3rd, Kucan JO, Roth A, et al: In vitro toxicity testing for antibacterials against human keratinocytes. Plast Reconst Surg 1991; 87:917–924PubMedGoogle Scholar
  62. 62.
    Cooper ML, Laxer JA, Hansbrough JF: The cytotoxic effects of commonly used topical antimicrobial agents on human fibroblasts and keratinocytes. J Trauma 1991; 31:775–784PubMedGoogle Scholar
  63. 63.
    Leyden JJ, Bartelt NM: Comparison of topical antibiotic ointments, a wound protectant, and antiseptics for the treatment of human blister wounds contaminated with Staphylococcus aureus. J Fam Pract 1987; 24:601–604PubMedGoogle Scholar
  64. 64.
    Tatnall FM, Leigh IM, Gibson JR: Comparative study of antiseptic toxicity on basal keratinocytes, transformed human keratinocytes and fibroblasts. Skin Pharmacol 1990; 3:157–163PubMedGoogle Scholar
  65. 65.
    Boyce ST, Warden GD, Holder IA: Noncytotoxic combinations of topical antomocrobial agents for use with cultured skin substitutes. Antimic Agents Chemother 1995; 39:1324–1328Google Scholar
  66. 66.
    Rietchel RL, Fowler JF: The role of age, sex and color of skin in contact dermatitis. In: Rietchel RL, Fowler JF (eds) Fisher's Contact Dermatitis, 4th edn. Baltimore: Williams & Wilkins. 1995; pp 41–65Google Scholar
  67. 67.
    Dooms-Goossens A, Degreef H, Parijs M, et al: A retrospective study of patch test results from 163 patients with stasis dermatitis or leg ulcers. Dermatologica 1979; 159:93–100PubMedGoogle Scholar
  68. 68.
    Wilson CL, Cameron J, Powell SM, et al: High incidence of contact dermatitis in leg-ulcer patients — implications for management. Clin Exp Dermatol 1991; 16:250–253PubMedGoogle Scholar
  69. 69.
    Fraki JE, Peltonen L, Hopsu-Havu VK: Allergy to various components of topical preparations in stasis dermatitis and leg ulcer. Contact Dermatitis 1979; 5:97–100PubMedGoogle Scholar
  70. 70.
    Zaki I, Shall L, Dalziel KL: Bacitracin: a significant sensitizer in leg ulcer patients? Contact Dermatitis 1994; 31:92–94PubMedGoogle Scholar
  71. 71.
    Lindemayr H, Drobil M: Eczema of the lower leg and contact allergy. Hautarzt 1985; 36:227–231PubMedGoogle Scholar
  72. 72.
    Reichert-Penetrat S, Barbaud A, Weber M, et al: Leg ulcers. Allergologic studies of 359 cases. Ann Dermatol Venereol 1999; 126:131–135PubMedGoogle Scholar
  73. 73.
    Nishioka K, Seguchi T, Yasuno H, et al: The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations. Contact Dermatitis 2000; 42:90–94CrossRefPubMedGoogle Scholar
  74. 74.
    Erdmann S, Hertl M, Merk HF: Allergic contact dermatitis from povidone-iodine. Contact Dermatitis 1999; 40:331–332PubMedGoogle Scholar
  75. 75.
    Niedner R: Cytotoxicity and sensitization of povidone-iodine and other frequently used unti-infective agents. Dermatology 1997; 195:89–92Google Scholar
  76. 76.
    Waran KD, Munsick RA: Anaphylaxis from povidone-iodine. Lancet 1995; 345:1506CrossRefGoogle Scholar
  77. 77.
    Reynolds NJ, Harman RR: Allergic contact dermatitis from chlorhexidine diacetate in a skin swab. Contact Dermatitis 1990; 22:103–104PubMedGoogle Scholar
  78. 78.
    Degreef H, Dooms-Goossens A: Patch testing with silver sulfadiazine cream. Contact Dermatitis 1985; 12:33–37PubMedGoogle Scholar
  79. 79.
    McKenna SR, Latenser BA, Jones LM, et al: Serious silver sulphadiazine and mafenide acetate dermatitis. Burns 1995; 21:310–312CrossRefPubMedGoogle Scholar
  80. 80.
    Van Den Hoogenband HM: Treatment of leg ulcers with split-thickness skin grafts. Dermatol Surg Oncol 1984; 10:605–608Google Scholar
  81. 81.
    Gasset AR, Ishii Y: Cytotoxicity of chlorhexidine. Can J Ophthalmol 1975; 10:98–100PubMedGoogle Scholar
  82. 82.
    Faddis D, Daniel D, Boyer J: Tissue toxicity of antiseptic solutions. A study of rabbit articular and periarticular tissues. J Trauma 1977; 17:895–897PubMedGoogle Scholar
  83. 83.
    Kimbrough RD: Review of the toxicity of hexachlorophene. Arch Environ Health 1971; 23:119–122PubMedGoogle Scholar
  84. 84.
    Disinfectants and preservatives. In: Kathleen Parfitt (ed) Martindale — The Complete Drug Reference. 32nd edn. London: Pharmaceutical Press. 1999; pp 1116–1117Google Scholar
  85. 85.
    Drosou A, Falabella A, Kirsner RS: Antiseptics on wounds: An area of controversy. Wounds 2003; 15:149–166Google Scholar
  86. 86.
    Eaglstein WH, Falanga V: Chronic wounds. Surg Clin North Am 1997; 77:689–700PubMedGoogle Scholar
  87. 87.
    Monafo WW, Freedman B: Topical therapy for burns. Surg Clin North Am 1987; 67:133–145PubMedGoogle Scholar
  88. 88.
    Pirnay JP, De Vos D, Cochez C, et al: Molecular epidemiology of Pseudomonas aeruginosa colonization in a burn unit: persistence of a multidrug-resistant clone and a silver sulfadiazine-resistant clone. J Clin Microbiol 2003; 41:1192–1202CrossRefPubMedGoogle Scholar
  89. 89.
    Wilson MJ, Weightman AJ, Wade WG: Applications of molecular ecology in the characterization of uncultured microorganisms associated with human disease. Rev Med Microbiol 1997; 8:91–101Google Scholar
  90. 90.
    Caputo GM, Cavanagh PR, Ulbrecht JS, et al: Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994; 331:854–860CrossRefPubMedGoogle Scholar
  91. 91.
    Slater R, Ramot Y, Rapoport M: Diabetic foot ulcers: principles of assessment and treatment. Isr Med Assoc J 2001; 3:59–62PubMedGoogle Scholar
  92. 92.
    Slater R, Lazarovitch Z, Boldur I, et al: Culturing the infected diabetic foot ulcer: swabs versus tissue specimens. In: Israel Diabetes Annual: Proceedings of the 18th meeting of the Israel Diabetes Association. Tel Aviv, Israel, 2001Google Scholar
  93. 93.
    Basak S, Dutta SK, Gupta S, et al: Bacteriology of wound infection: evaluation by surface swab and quantitative full thickness wound biopsy culture. J Indian Med Assoc 1992; 90:33–34PubMedGoogle Scholar
  94. 94.
    Pellizzer G, Strazzabosco M, Presi S, et al: Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection. Diabet Med 2000; 18:822–827CrossRefGoogle Scholar
  95. 95.
    Wheat LJ, Allen SD, Henry M, et al: Diabetic foot infections: Bacteriologic analysis. Arch Intern Med 1986; 146:1935–1940CrossRefPubMedGoogle Scholar
  96. 96.
    Lee PC, Turnidge J, McDonald PJ: Fine-needle aspiration biopsy in diagnosis of soft tissue infections. J Clin Microbiol 1985; 22:80–83PubMedGoogle Scholar
  97. 97.
    Sapico FL, Witte JL, Canawati HN, et al: The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features. Rev Infect Dis 1984; 6:S171–S176PubMedGoogle Scholar
  98. 98.
    Buchanan K, Heimbach DM, Minshew BH, et al: Comparison of quantitive and semiquantitative culture techniques for burn biopsy. J Clin Microbiol 1986; 23:258–261PubMedGoogle Scholar
  99. 99.
    Bello YM, Falabella AF, DeCaralho H, et al: Infection and wound healing. Wounds 2001; 13:127–131Google Scholar
  100. 100.
    Davis SC, Mertz PM, Eaglstein WH: The wound environment: implications from research studies for healing and infection. In: Krasner D, Rodeheaver G, Sibbald G (eds) Chronic Wound Care, 1st edn. Wayne, PA: HMP Communications. 2001; pp 253–263Google Scholar
  101. 101.
    Potera C: Forging a link between biofilms and disease. Science 1999; 283:1837–1839CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Personalised recommendations