antibiotics for pressure sore infection

omeleteman · 06-28-2003, 11:56 AM

hi there.
I know only exams would detect the correct antibiotic to solve pressure sore now and then infections, but would you know what are the most commons and effective ones?
Thanks and hugs to all.

omeleteman · 06-30-2003, 03:26 PM

No one can help?

SCI-Nurse · 06-30-2003, 05:29 PM

There is rarely an indication for taking antibiotics just because you have a pressure ulcer. If you culture the surface of the pressure ulcer, you will get bacteria, but rarely are they causing a systemic infection.

Similar to colonization in the urine, if you treat for just surface contamination you are likely to end up with resistant bacteria, both in your wound and in your bladder.

Antibiotics should be used only for systemic infection (elevate WBC, elevated sed rate, fever) that is definately from the pressure ulcer, cellulitis associated with a pressure ulcer, osteomyelitis associated with the pressure ulcer, or just before or just after flap surgery. These should be based on tissue culture (where a piece of soft tissue or bone is actually cut out and cultured), not just a culture of the wound drainage/surface.

If a wound is purulent (has pus-like drainage) then using a topical antiseptic such as 1/4% Dakins solution (moist gauze) or silver-impregnated dressings or ointment (like Silvadene) can reduce the number of bacteria without causing damage to to the wound bed, or risking the development of resistance. Once the pus is gone, this should be changed back to treatment with a moist physiologic safe treatment, normally normal saline gauze or a hydrocolloid or other similar dressing.

The key is to keep the wound bed moist, clean, covered, and to keep all pressure off the area until it is completely healed.

(KLD)

omeleteman · 06-30-2003, 06:01 PM

Thanks Nurse.
My pressure sore now and then causes me fever.
Doctors indicate cefalexin but last turn it happened I had 14 days (2 grams/day) of cefalexin and fever didn't stop.

SCI-Nurse · 07-01-2003, 08:03 AM

Fernando, how deep is your pressure ulcer (what stage)? Do you have osteomyelitis (bone infection) under the ulcer?

As with any antibiotic, the selection must be based on appropriate culture and sensitivity tests. Have you had a tissue biopsy culture (not just culture of your drainage)?

(KLD)

omeleteman · 07-02-2003, 10:37 AM

Doctor said it is stage 3 and we didn´t have culture cause I had taken cefalexin antibiotic.
Thay say there´s no osteomyelitis

whiterabbit11 · 07-02-2003, 08:52 PM

KLD,
you advised that antibiotics should only be used when symptoms become systemic indicated by fever, elevated WBC etc. My urologist prescribes low dosage antibiotics all the time to prevent uti's. 1 Bactrim per day for a week followed by 500mg (?) macrobid each day for the next week, 500mg Cipro once a day for the 3rd. nothingb the 4th then repeat. Does this seem appropriate to you or can It cause bacterial immunity? It seems to cut down on the frequency of uti's but your opinion would be appreciated.WR

SCI-Nurse · 07-02-2003, 11:48 PM

This question was specifically about use of antibiotics in pressure ulcer treatment, but yes, I would be very concerned that over the long run a regimen such as this would cause you to develop colonization with bacteria that are resistant to all 3 of these drugs.

The concern is that if you should then develop a systemic infection (ie, septicemia) from one of these bugs that you would have no choice but to use the more toxic "big gun" antibiotics, or that there might not be any antibiotic that would work.

I would refer you to this publication from AHQR:

http://www.ahrq.gov/clinic/utisumm.htm

You might want to print this and share with your physician and discuss this decision.

(KLD)

06-28-2003, 11:56 AM	#1
omeleteman Senior Member Join Date: Aug 2001 Location: Rio de Janeiro-Brazil Posts: 170	antibiotics for pressure sore infection hi there. I know only exams would detect the correct antibiotic to solve pressure sore now and then infections, but would you know what are the most commons and effective ones? Thanks and hugs to all.

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06-30-2003, 03:26 PM	#2
omeleteman Senior Member Join Date: Aug 2001 Location: Rio de Janeiro-Brazil Posts: 170	No one can help?

06-30-2003, 05:29 PM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,354	There is rarely an indication for taking antibiotics just because you have a pressure ulcer. If you culture the surface of the pressure ulcer, you will get bacteria, but rarely are they causing a systemic infection. Similar to colonization in the urine, if you treat for just surface contamination you are likely to end up with resistant bacteria, both in your wound and in your bladder. Antibiotics should be used only for systemic infection (elevate WBC, elevated sed rate, fever) that is definately from the pressure ulcer, cellulitis associated with a pressure ulcer, osteomyelitis associated with the pressure ulcer, or just before or just after flap surgery. These should be based on tissue culture (where a piece of soft tissue or bone is actually cut out and cultured), not just a culture of the wound drainage/surface. If a wound is purulent (has pus-like drainage) then using a topical antiseptic such as 1/4% Dakins solution (moist gauze) or silver-impregnated dressings or ointment (like Silvadene) can reduce the number of bacteria without causing damage to to the wound bed, or risking the development of resistance. Once the pus is gone, this should be changed back to treatment with a moist physiologic safe treatment, normally normal saline gauze or a hydrocolloid or other similar dressing. The key is to keep the wound bed moist, clean, covered, and to keep all pressure off the area until it is completely healed. (KLD)

06-30-2003, 06:01 PM	#4
omeleteman Senior Member Join Date: Aug 2001 Location: Rio de Janeiro-Brazil Posts: 170	Thanks Nurse. My pressure sore now and then causes me fever. Doctors indicate cefalexin but last turn it happened I had 14 days (2 grams/day) of cefalexin and fever didn't stop.

07-01-2003, 08:03 AM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,354	Fernando, how deep is your pressure ulcer (what stage)? Do you have osteomyelitis (bone infection) under the ulcer? As with any antibiotic, the selection must be based on appropriate culture and sensitivity tests. Have you had a tissue biopsy culture (not just culture of your drainage)? (KLD)

07-02-2003, 10:37 AM	#6
omeleteman Senior Member Join Date: Aug 2001 Location: Rio de Janeiro-Brazil Posts: 170	Doctor said it is stage 3 and we didn´t have culture cause I had taken cefalexin antibiotic. Thay say there´s no osteomyelitis

07-02-2003, 08:52 PM	#7
whiterabbit11 Senior Member Join Date: Feb 2002 Location: middle of nowhere Posts: 565	KLD, you advised that antibiotics should only be used when symptoms become systemic indicated by fever, elevated WBC etc. My urologist prescribes low dosage antibiotics all the time to prevent uti's. 1 Bactrim per day for a week followed by 500mg (?) macrobid each day for the next week, 500mg Cipro once a day for the 3rd. nothingb the 4th then repeat. Does this seem appropriate to you or can It cause bacterial immunity? It seems to cut down on the frequency of uti's but your opinion would be appreciated.WR

07-02-2003, 11:48 PM	#8
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,354	This question was specifically about use of antibiotics in pressure ulcer treatment, but yes, I would be very concerned that over the long run a regimen such as this would cause you to develop colonization with bacteria that are resistant to all 3 of these drugs. The concern is that if you should then develop a systemic infection (ie, septicemia) from one of these bugs that you would have no choice but to use the more toxic "big gun" antibiotics, or that there might not be any antibiotic that would work. I would refer you to this publication from AHQR: http://www.ahrq.gov/clinic/utisumm.htm You might want to print this and share with your physician and discuss this decision. (KLD)