Time to Abandon Antimicrobial Approaches in Wound Healing

A Paradigm Shift

Jeanette Sams-Dodd, BSc, BScVet; Frank Sams-Dodd, PhD, Dr.med

Disclosures

Wounds. 2018;30(11):345-352. 

In This Article

Conclusions

As of now, MPPT is the only therapy available that relies on this type of mode of action, but it demonstrates that it is feasible to remove infections without antimicrobial action and points to the possibility of pursuing completely new principles for the treatment of infection on external surfaces that harbor a microbiome. The data obtained with MPPT furthermore question the value of antimicrobial approaches and whether their routine use should be continued given that a number of meta-analysis studies[23–32] have not shown they provide clear medical benefits, given the high number of wounds that are nonhealing and that they contribute to the creation of antimicrobial resistance. The strong focus on antimicrobial approaches primarily stems from antibiotics and their highly successful use in the treatment of internal infections. This has led to the assumption in wound care that a reduction in microbial load equals a reduction in wound infection, but this assumption is not supported by clinical data. Therefore, as the body employs fundamentally different strategies for its protection against pathogens on external surfaces, it might be worth considering whether the treatment focus should follow a similar distinction. After all, the body might have its reasons as it has been dealing with this problem on an evolutionary timescale. Consequently, it may be time to propose a paradigm shift in the treatment of wounds away from antimicrobial approaches and towards approaches that support the immune system and the microbiome.

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