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Topical Antimicrobials

- See:
      - wound management
      - pressure irrigation

- Discussion:
    - skin prep agents:
           - iodophors;
           - chlorohexidine;
    - topical agents administered should be effective against Pen-Res Staph aureus and epidermidis, as well, as gram neg (E.coli, Klebsiella),
           and Proteus (gm neg accounting for upto 1/3 of total joint infections);
    - neomycin
    - bacitracin
           - in concentrations as low as 50,000 units/L and polymyxin in concentrations as low as 50 mg/liter sterilized all cultures but S.epidermidis
                    and Proteus species; - use 50 units per ml;
    - triple ATB:
           - lowest concentrations of a triple ATB solution that eradicated all organisms were 5% neomycin (5-10 mg/ml), bacitracin 25,000 units/liter, and
                      polymyxin 25 mg/liter (0.05 mg per ml)
           - these agents should be allowed to remain in the wound for atleast one minute before their removal;
    - mafenide acetate tested at a clinical concentration of 10% resulted in average cell survival of 73 % of the population.
    - mupirocin
           - Decrease in infections with the introduction of mupirocin cream at the peritoneal dialysis catheter exit site.

Local tissue effects of wound disinfectants.  
Tissue injury caused by wound disinfectants.
Disinfection of surgical wounds without inhibition of normal wound healing.
Cellular and bacterial toxicities of topical antimicrobials.
Topical antimicrobial toxicity.
Bactericidal and wound-healing properties of sodium hypochlorite solutions: the 1991 Lindberg Award.
Antiseptic effectiveness with fibroblast preservation.
Antiseptic toxicity in wounds healing by secondary intention.
The Cytotoxic Effects of Commonly Used Topical Antimicrobial Agents on Human Fibroblasts and Keratinocytes.
In Vitro Toxicity Testing for Antibacterials Against Human Keratinocytes.
Selection of topical antimicrobial agents for cultured skin for burns by combined assessment of cellular cytotoxicity and antimicrobial activity.
Cytotoxicity to cultured human keratinocytes of topical antimicrobial agents.
A review of the evidence for the use of topical antimicrobial agents in wound care
Antiseptics on Wounds: An Area of Controversy
Studies in management of the contaminated wound. I. Technique of closure of such wounds together with a note on a reproducible experimental model.
Evaluation of protocol change in burn-care management using the Cox proportional hazards model with time-dependent covariates.
Acceleration of wound healing by topical application of honey. An animal model.
Successful treatment of chronically infected wounds with sugar paste.      
Studies in management of the contaminated wound. 3. Assessment of the effectiveness of irrigation with antiseptic agents.
Studies in the management of the contaminated wound. V. An assessment of the effectiveness of pHisoHex and Betadine surgical scrub solutions.
Studies in the management of the contaminated wound. 8. Assessment of tissue adhesives for repair of contaminated tissue.
Air Embolism Associated with Irrigation of External Fixator Pin Sites with Hydrogen Peroxide. A Report of Two Cases.
Comparison of bactericidal activities of various disinfectants against methicillin-sensitive Staphylococcus aureus and methicillin-resistant Staphylococcus aureus.