Systemic antimicrobial therapy

Although use of systemic antimicrobials for chronic wounds is common, they should not be used unless there are clinical signs of spreading or systemic infection. Systemic antimicrobials should always be used in combination with optimal local wound management, including adequate cleansing and debridement. The choice of antimicrobial should be based on the suspected pathogen, location of infection, patient characteristics (recent hospitalisation, previous microbiology, colonisation with a multidrug-resistant organism) and severity of infection.

Virulent or difficult-to-treat bacteria include resistant strains of Staphylococcus aureus, beta-haemolytic streptococci, and (in certain circumstances) Pseudomonas aeruginosa. For treatment recommendations, see Directed therapy for bloodstream infections, including sepsis and septic shock, Diabetic foot infection, Cellulitis and erysipelas and Osteomyelitis.

The route of antibiotic therapy is based on severity of infection, bioavailability of the antibiotic, penetration of the antibiotic to the site of infection and susceptibility of the pathogen. Use oral therapy for mild infections. Intravenous therapy may be required for severe infections or if penetration at the site of infection is limited (eg for osteomyelitis, diabetic foot infection in a patient with peripheral arterial disease).

The duration of antibiotic therapy depends on the organism isolated, the location of infection, type of wound and patient's comorbidities. Principles of antimicrobial stewardship should always be maintained.