Systemic antibiotics do not improve healing of venous leg ulcers

Clinical question: 
How effective are systemic antibiotics and antiseptics in healing venous ulcers?
Bottom line: 
There is no evidence to support the routine use of systemic antibiotics to promote healing in venous leg ulcers. One study (involving daily dressings and bed rest but no compression) showed a statistically significant result in favour of cadexomer iodine (a topical agent with debriding and antibacterial effects) when compared with standard care in terms of frequency of complete healing at 6 weeks (NNT*5). However, only 60 patients were involved in the final analysis. *NNT = number needed to treat to benefit 1 individual.
The regimen used with cadexomer iodine was intensive and hospital based, and so these findings may not have been generalisable to most everyday clinical settings. Further good quality research is required before definitive conclusions can be made about the effectiveness of systemic antibiotics and topical agents, such as povidone iodine, peroxide-based preparations, ethacridine lactate and muciprocin. In the light of the increasing problems of bacterial resistance to antibiotics, current prescribing guidelines recommend antibacterial preparations should only be used in cases of defined infection and not for bacterial colonisation.
Venous leg ulcers affect up to 1% of adults in developed countries at some point during their life. Many of the wounds are colonised by bacteria or show signs of clinical infection, which may delay ulcer healing.
Review CD#: 
June, 2008
Authored by: 
Brian R McAvoy