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    Topical antimicrobial dressings for infected leg ulcers in people 16 years and over: late-stage assessment

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    2 The technology

    2.1

    Topical antimicrobial dressings are dressings that contain an antimicrobial agent, which they deliver directly to the wound or wound bed to provide sustained antimicrobial effects. They are one of the options available to healthcare professionals when treating infected leg ulcers. There are various types of wound care dressings, with different intended clinical benefits. These are shown in table 1.

    Table 1 Types of dressings and their uses

    Dressing types

    Uses

    Alginate, gelling fibre and absorbent fibre

    Exuding wounds, to act as an absorbent while maintaining a moist environment

    Foams and absorbent pads

    Moderate to high exuding wounds

    Wound contact layers, for example gauze

    Superficial or partial thickness wounds

    Ointments, hydrogels, gels or pastes containing the antimicrobial agent, or ribbons made from one of the materials from another dressing type

    Deeper wounds and wounds requiring debridement of thick slough

    Hydrocolloid

    Aiding debridement of devitalised tissue

    2.2

    As well as different types of dressing, there are different antimicrobial agents used in dressings. These are the focus of this assessment. Chemically or pharmacologically active antimicrobial agents include:

    • silver

    • chitosan

    • honey

    • iodine

    • copper

    • chlorhexidine

    • enzyme alginogel

    • octenidine and

    • polyhexamethylene biguanide (PHMB).

    Non-active agents with a physical mode of action include dialkylcarbamoyl chloride (DACC).

    2.3

    Some agents are available in different forms (described as subagents). For example:

    • honey:

      • Manuka

      • monofloral

      • polyfloral

    • iodine:

      • cadexomer iodine

      • povidone iodine

    • silver, the subagents of which can be categorised into 3 subgroups:

      • silver salts and compounds:

        • ionic silver

        • silver sulphate

        • silver sulphadiazine

        • silver oxysalts

        • ionic silver complex

      • elemental silver:

        • metallic or elemental silver and

        • nanoparticulate silver and

      • ionic silver with antibiofilm agents

    • copper: cupric oxide.

    2.4

    There are many antimicrobial dressings available to the NHS. For this assessment NICE considered antimicrobial dressings listed on the NHS Drug Tarriff Part IX.