Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration


Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general.

The aim of this review was to assess the clinical- and cost-effectiveness of prevention and treatment strategies for diabetic foot ulcers and systemic and topical antimicrobial agents in the prevention and healing of chronic wounds.


Much uncertainty remains over the most effective interventions for the prevention and treatment of diabetic foot ulcers. Certain treatments (e.g. growth factors and off-loading techniques such as total contact casting) show promise but need further, more rigorous evaluation.

There is no existing evidence to support the use of systemic antimicrobial agents for chronic wound healing. Even with interventions that appear to be promising, further, more rigorous evaluation is required before use becomes routine, as existing trials are generally small and many have other methodological problems. Several topical agents may be helpful, but again further research is required to establish effectiveness. Until improved data on relative effectiveness become available, considerations such as cost-minimisation may be used to guide decisions on the use of antimicrobial agents.

Conducted by: S O'Meara1, N Cullum2, M Majid3, T Sheldon4

1. NHS Centre for Reviews and Dissemination; 2. Centre for Evidence Based Nursing, University of York; 3. Department of Psychology, University of Newcastle upon Tyne; 4. Department of Health Studies, University of York

Further details

Project page on HTA Programme website


O'Meara S, Cullum N, Majid M, Sheldon T. Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assess. 2000;4(21):1-237


Commissioned by the HTA Programme