Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Topical Antimicrobal Agents

Topical Antimicrobials Useful in Wounds with Overt and Covert Infection

Agent:

 

Agent  Cadexomer Iodine
S. Aureus +
MRSA +
Streptococcus +
Pseudomonas +
Anaerobes +
Comments Also debrides. Low potential for resistance. Caution with thyroid disease.
Summary Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Silver
S. Aureus +
MRSA +
Streptococcus +
Pseudomonas +
Anaerobes +
Comments Do not use with saline. Low potential for resistance.
Summary Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Silver Sulfadiazine
S. Aureus +
MRSA +
Streptococcus +
Pseudomonas +
Anaerobes +
Comments Caution with sulphonamide sensitivity
Summary Low risk and effective

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Polymycin B
Sulphate/Bacitracin
Zinc
S. Aureus +
MRSA +
Streptococcus +
Pseudomonas +
Anaerobes +
Comments Bacitracin in the ointment is an allergen; the cream formulation contains the less-sensitizing gramicidin.
Summary Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Mupirocin
S. Aureus  
MRSA +
Streptococcus  
Pseudomonas  
Anaerobes  
Comments Reserve for MRSA and other resistant Gram+ species
Summary Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Metrondiazole
S. Aureus  
MRSA  
Streptococcus  
Pseudomonas  
Anaerobes +
Comments Reserve for anaerobes and odour control. Low or no resistance of anaerobes despite systemic use.
Summary Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Benzoyl peroxide
S. Aureus Weak
MRSA Weak
Streptococcus Weak
Pseudomonas  
Anaerobes Weak
Comments Large wounds. Can cause irritation and allergy.
Summary Use selectively

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Gentamicin
S. Aureus +
MRSA  
Streptococcus +
Pseudomonas +
Anaerobes  
Comments Reserve for oral/IV use-topical use may encourage resistance.
Summary Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Fusidin ointment
S. Aureus +
MRSA  
Streptococcus +
Pseudomonas  
Anaerobes  
Comments Contains lanolin (except in the cream).
Summary Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Agent  Polymyxin B
sulphate/Bacitracin
zinc neomycin
S. Aureus +
MRSA +
Streptococcus +
Pseudomonas +
Anaerobes +
Comments Neomycin component causes allergies, and possibly cross-sensitizes to aminoglycosides.
Summary Use with caution

Where "+" indicates the infection(s) to which the agent is useful.

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Source: Sibbald, Orsted et al. (2006). Reprinted with permission.