The downside of antimicrobial agents for wound healing

AbstractThe use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause ofdelayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewersystemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided intothree groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore,this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, theirdisadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activitythan antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still manyadverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects ofcommonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin,mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, theantimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awarenessfor antimicrobial selection in those populations.Keywords Topical antimicrobials . Wounds . Adverse effect . Toxicit