Antiseptics and antimicrobials for the treatment and management of chronic wounds: a systematic review of clinical trials

Introduction: The development of the field related to the treatment of wounds has resulted in the appearance of new antimicrobial active ingredients. Aim: To analyse, evaluate and systematize the available scientific evidence of the effectiveness and safety of anti-septic preparations intended for the treatment of chronic wounds. Material and methods: We conducted a literature review using the advanced search engine in the PubMed database. We used a combination of two English keywords, i.e.: "antiseptic" and "chronic wound". We have selected only clinical, randomized controlled trials. Results: We obtained a total of 825 items (674 full-text works). We included 29 studies in the review. The most frequently evaluated preparation was octenidine dihydrochloride and povidone iodine (pharmacological drugs). Preparations containing polyhexanide, products based on hypochlorite, reactive oxygen species, 1% acetic acid, and specialized antibacterial dressings were also assessed. The new generation of antimicrobial preparations were highly effective, both in the prevention and treatment of infections, and were well tolerated by the tissues and do not interfere with the healing process. The best tolerated and most effective antiseptic was OCT/PE. For cleaning, we recommend OCT-based irrigation fluids, PHMB, or hypochlorite. The maintenance of the antimicrobial effect during the therapy was ensured by a compatible dressing. Conclusions: An antiseptic alone is not effective enough and the therapeutic effect depends to the greatest extent on properly selected causal therapy, preceded by thorough diagnostics.