The use of topical antimicrobials in wound bioburden control

The control of wound bioburden is believed to be valuable in avoiding possible deterioration into infection; in reducing critical colonization; and in treating frank infection. While the immune response is the governing factor in the development of infection, the reduction of bioburden – if achieved to a sufficient degree and for sufficient duration – can enable host defences to regain control. Topical antimicrobial agents, carefully selected and correctly dosed, can help achieve these goals. This review examines the value of topical antiseptics and antibiotics in various formulations in controlling the bioburden of acute and, predominantly, chronic wounds. The currently held perception of antibiotic misuse is reinforced and reiterated. Topical antibiotics must be used with caution and only for specific, limited indications. Topical antiseptics have a much broader range of applications and are generally safer when used appropriately. Conditions and circumstances of use are provided for these agents.