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JAMA Clinical Evidence Synopsis |

Topical and Systemic Antimicrobial Therapy for Venous Leg Ulcers

Susan O’Meara, PhD1; Rachel Richardson, MA, MBA2; Benjamin A. Lipsky, MD, FRCP3,4,5
[+] Author Affiliations
1School of Healthcare, Baines Wing, University of Leeds, England
2Cochrane Wounds Group, Department of Health Sciences, University of York, York, England
3Department of Medicine, University of Washington, Seattle
4Department of Infectious Diseases, University of Geneva, Geneva, Switzerland
5Green Templeton College, University of Oxford, Oxford, England
JAMA. 2014;311(24):2534-2535. doi:10.1001/jama.2014.4574.
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Clinical Question  Is treatment with topical or systemic antimicrobial agents associated with better venous leg ulcer healing compared with usual care (dressings and bandages without antimicrobials) or an alternative topical or systemic antimicrobial agent?

Bottom Line  Available evidence, from underpowered pooled data, neither supports nor refutes an association of systemic antibiotic therapy with improved venous leg ulcer healing. Among topical antimicrobials, cadexomer iodine may be associated with better healing compared with usual care.

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Figure.
Risk Ratios for Complete Venous Leg Ulcer Healing Among Patients Treated With Systemic or Topical Antimicrobial Agent vs Usual Care

Source: Data adapted with permission from Wiley.1 Risk ratio estimates were plotted on a log scale. Control treatment was most often usual care (cleansing, dressings, and bandages without antimicrobial therapy).aNo mention or unclear report of ulcer infection at baseline.bEligible patients had clinically infected ulcers at baseline.cEligible patients had ulcers described as “critically colonized.”dPatients using systemic antibiotics were excluded.

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