Antiseptics on Wounds: An Area of Controversy

Anna Drosou, MD, Anna Falabella, MD, Robert S. Kirsner, MD

Disclosures

Wounds. 2003;15(5) 

In This Article

Discussion

The use of antiseptics on wounds is currently being viewed with skepticism. Results from in-vitro studies have shown that antiseptics are toxic not only against bacteria and other microorganisms but also against human cells essential to the wound healing response. These findings resulted in a series of animal and human studies in order to evaluate the in-vivo activity of antiseptics. However, it seems that in human subjects, pronounced cytotoxicity, found in vitro, was not confirmed. In the majority of clinical trials, antiseptics appear to be safe and were not found to negatively influence wound healing. Their antimicrobial efficiency, with the exception of hydrogen peroxide, seems satisfactory as well. Randomized controlled studies to evaluate the effect of each antiseptic on the different kinds of wounds (acute, venous, diabetic, or pressure ulcers) are indicated to provide greater evidence regarding the benefits of antiseptic use on wounds. Efforts to develop superior antiseptic formulations are likely to and should continue. Development of cadexomer iodine, which not only does not negatively influence wound healing but also accelerates healing even in noninfected wounds, and development of improved silver delivery systems, which release silver more efficiently than previous formulations while enhancing re-epithelization, are paradigms of the therapeutic potential of antiseptics. Vehicles that contribute to the maintenance of an optimal moist environment may be more appropriate as delivery systems of antiseptics than the current ones, since moist environments result in both increased wound healing rate and enhancement of antimicrobial penetration to wounds.

Antiseptics need not be omitted from the therapeutic armamentarium of wound care. In patients and wound types with high risk of infection, antiseptics may be used to prevent wound infection that would have deleterious effects on wound healing. Antiseptics present advantages over topical antibiotics, since they do not cause the emergence of drug-resistant bacteria and have broader antimicrobial spectrum and lower sensitization rates.

In conclusion, after review of the literature, most antiseptics, especially newer formulations, appear to be relatively safe and efficient in preventing infection in human wounds. The advantages of antiseptics on wounds may outweigh possible disadvantages, and their position in wound care management should be reconsidered.

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