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Antibiotics and antiseptics for venous leg ulcers

  1. Susan O'Meara1,*,
  2. Deyaa Al-Kurdi2,
  3. Yemisi Ologun3,
  4. Liza G Ovington4,
  5. Marrissa Martyn-St James5,
  6. Rachel Richardson6

Editorial Group: Cochrane Wounds Group

Published Online: 23 DEC 2013

Assessed as up-to-date: 24 MAY 2013

DOI: 10.1002/14651858.CD003557.pub4


How to Cite

O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD003557. DOI: 10.1002/14651858.CD003557.pub4.

Author Information

  1. 1

    University of Leeds, School of Healthcare, Leeds, UK

  2. 2

    University of York, The Cochrane Wounds Group, York, North Yorkshire, UK

  3. 3

    Chesterfield Royal Hospital, Calow, Derbyshire, UK

  4. 4

    Ethicon, Inc, Somerville, New Jersey, USA

  5. 5

    University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, South Yorkshire, UK

  6. 6

    University of York, Department of Health Sciences, York, UK

*Susan O'Meara, School of Healthcare, University of Leeds, Room LG.12, Baines Wing, Leeds, LS2 9JT, UK. s.m.omeara@leeds.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 23 DEC 2013

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This is not the most recent version of the article. View current version (10 JAN 2014)

[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
[Figure 3]
Figure 3. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
[Figure 4]
Figure 4. Forest plot of comparison: 8 Cadexomer iodine versus standard care, outcome: 8.1 Frequency of complete healing at 4 to 12 weeks.
[Figure 5]
Figure 5. Forest plot of comparison: 18 Honey products versus alternatives, outcome: 18.1 Complete healing at 12 weeks.
[Figure 6]
Figure 6. Forest plot of comparison: 23 Silver dressing versus non-antimicrobial dressing, outcome: 23.1 Complete healing at 4 to 12 weeks.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Systemic antibiotic given according to sensitivities versus standard care, Outcome 1 Complete healing at 3 weeks.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Systemic antibiotic given according to sensitivities versus standard care, Outcome 2 Complete healing—eventual, assessment point not stated.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Systemic antibiotic given according to sensitivities versus standard care, Outcome 3 Bacterial eradication.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Ciprofloxacin versus standard care/placebo, Outcome 1 Frequency of complete healing.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Ciprofloxacin versus standard care/placebo, Outcome 2 Emergence of antibiotic-resistant strains.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Ciprofloxacin versus standard care/placebo, Outcome 3 Bacterial eradication.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Ciprofloxacin versus trimethoprim, Outcome 1 Frequency of complete healing.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Ciprofloxacin versus trimethoprim, Outcome 2 Emergence of antibiotic-resistant strains.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Trimethoprim versus placebo, Outcome 1 Frequency of complete healing.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Trimethoprim versus placebo, Outcome 2 Emergence of antibiotic-resistant strains.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Amoxicillin plus compression verus povidone-iodine alone, Outcome 1 Frequency of complete healing.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Amoxicillin plus compression verus povidone-iodine plus compression, Outcome 1 Frequency of complete healing.
[Analysis 7.1]
Analysis 7.1. Comparison 7 Levamisole versus placebo, Outcome 1 Frequency of complete healing.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Cadexomer iodine versus standard care, Outcome 1 Frequency of complete healing at 4 to 12 weeks.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Cadexomer iodine versus standard care, Outcome 2 Adverse events.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Cadexomer iodine versus dextranomer, Outcome 1 Frequency of complete healing.
[Analysis 10.1]
Analysis 10.1. Comparison 10 Cadexomer iodine versus hydrocolloid dressing, Outcome 1 Frequency of complete healing.
[Analysis 11.1]
Analysis 11.1. Comparison 11 Cadexomer iodine versus paraffin gauze, Outcome 1 Frequency of complete healing.
[Analysis 12.1]
Analysis 12.1. Comparison 12 Cadexomer iodine dressing versus silver dressing, Outcome 1 Frequency of complete healing.
[Analysis 12.2]
Analysis 12.2. Comparison 12 Cadexomer iodine dressing versus silver dressing, Outcome 2 Participant satisfaction.
[Analysis 13.1]
Analysis 13.1. Comparison 13 Povidone-iodine plus sugar versus growth factor, Outcome 1 Frequency of complete healing at 4 weeks.
[Analysis 14.1]
Analysis 14.1. Comparison 14 Povidone-iodine plus compression versus hydrocolloid plus compression, Outcome 1 Frequency of complete healing.
[Analysis 15.1]
Analysis 15.1. Comparison 15 Povidone-iodine plus compression versus moist or foam dressings plus compression, Outcome 1 Complete healing at 4 weeks.
[Analysis 16.1]
Analysis 16.1. Comparison 16 Peroxide-based topical preparation versus control, Outcome 1 Mean percentage ulcer area remaining.
[Analysis 17.1]
Analysis 17.1. Comparison 17 Honey products versus alternatives, Outcome 1 Complete healing at 12 weeks.
[Analysis 17.2]
Analysis 17.2. Comparison 17 Honey products versus alternatives, Outcome 2 Incidence of ulcer infection during the 12-week trial period.
[Analysis 17.3]
Analysis 17.3. Comparison 17 Honey products versus alternatives, Outcome 3 Participants with MRSA eradication at 4 weeks.
[Analysis 17.4]
Analysis 17.4. Comparison 17 Honey products versus alternatives, Outcome 4 Participants reporting at least 1 adverse event.
[Analysis 18.1]
Analysis 18.1. Comparison 18 1% silver sulphadiazine cream versus placebo cream, Outcome 1 Complete healing at 4 weeks.
[Analysis 19.1]
Analysis 19.1. Comparison 19 1% silver sulphadiazine cream versus 0.4% tripeptide copper complex cream, Outcome 1 Complete healing at 4 weeks.
[Analysis 20.1]
Analysis 20.1. Comparison 20 1% silver sulphadiazine cream versus non-adherent dressing, Outcome 1 Complete healing at 12 weeks.
[Analysis 21.1]
Analysis 21.1. Comparison 21 Silver dressing (Avance) versus silver dressing (Acticoat 7), Outcome 1 Complete healing at 12 weeks.
[Analysis 22.1]
Analysis 22.1. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 1 Complete healing at 4 to 12 weeks.
[Analysis 22.2]
Analysis 22.2. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 2 Complete healing at 6 months.
[Analysis 22.3]
Analysis 22.3. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 3 Complete healing at 12 months.
[Analysis 22.4]
Analysis 22.4. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 4 Ulcer recurrence within first year.
[Analysis 22.5]
Analysis 22.5. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 5 Change in ulcer surface area (cm squared) at 4 weeks.
[Analysis 22.6]
Analysis 22.6. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 6 Change in ulcer surface area (%) at 4 weeks.
[Analysis 22.7]
Analysis 22.7. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 7 Healing rate (cm squared per day).
[Analysis 22.8]
Analysis 22.8. Comparison 22 Silver dressing versus non-antimicrobial dressing, Outcome 8 Proportion of participants reporting any type of adverse event.
[Analysis 23.1]
Analysis 23.1. Comparison 23 Chloramphenicol-containing ointment versus enzymatic cleanser, Outcome 1 Complete healing at 4 weeks.
[Analysis 23.2]
Analysis 23.2. Comparison 23 Chloramphenicol-containing ointment versus enzymatic cleanser, Outcome 2 Participants discontinuing treatment because of ineffectiveness or allergy.
[Analysis 24.1]
Analysis 24.1. Comparison 24 Framycetin sulphate-containing ointment versus enzymatic cleanser, Outcome 1 Complete healing at 4 weeks.
[Analysis 24.2]
Analysis 24.2. Comparison 24 Framycetin sulphate-containing ointment versus enzymatic cleanser, Outcome 2 Participants discontinuing treatment because of ineffectiveness or allergy.
[Analysis 25.1]
Analysis 25.1. Comparison 25 Chloramphenicol-containing ointment versus framycetin sulphate-containing ointment, Outcome 1 Complete healing at 4 weeks.
[Analysis 25.2]
Analysis 25.2. Comparison 25 Chloramphenicol-containing ointment versus framycetin sulphate-containing ointment, Outcome 2 Participants discontinuing treatment because of ineffectiveness or allergy.
[Analysis 26.1]
Analysis 26.1. Comparison 26 Mupirocin versus control, Outcome 1 Frequency of complete healing.
[Analysis 26.2]
Analysis 26.2. Comparison 26 Mupirocin versus control, Outcome 2 Eradication of gram-positive bacteria.
[Analysis 27.1]
Analysis 27.1. Comparison 27 Topical antibiotics versus herbal ointment, Outcome 1 Complete healing at 7 weeks.
[Analysis 27.2]
Analysis 27.2. Comparison 27 Topical antibiotics versus herbal ointment, Outcome 2 Participants with bacterial eradication at 7 weeks.
[Analysis 28.1]
Analysis 28.1. Comparison 28 Ethacridine lactate versus control, Outcome 1 Number of responsive ulcers.
[Analysis 28.2]
Analysis 28.2. Comparison 28 Ethacridine lactate versus control, Outcome 2 Participants reporting at least 1 adverse event.
[Analysis 28.3]
Analysis 28.3. Comparison 28 Ethacridine lactate versus control, Outcome 3 Participant satisfaction (treatment rated as excellent).