Journal_1_2014_final_WEB

Science, Practice and Education
tive infections. This lack of information about chronic
ulcers may contribute to the uncertainty among physicians
regarding the use of antibiotic therapy in these cases. The
National Guidelines for antibiotics issued by the Norwegian
Health Directory for primary health services, which
is assumed to be the primary reference point for doctors
who are faced with a clinical uncertainty, should therefore
provide further guidance about when the prescription of
antibiotics is contraindicated.
Conclusion
The results of the current study suggest a significant excess
use of antibiotics in patients with non-healing ulcers.
Mounting evidence suggests that the use of antibiotics
should be reduced significantly among this population
because antibiotics do not treat the underlying cause of
the ulcer. A reduction of antibiotic use among this patient
population will significantly reduce antibiotic resistance
and health care costs associated with the side effects of
antibiotics.
Although the guidelines for antibiotic use should be
updated and improved for use by doctors in the primary
health services, research suggests that the guidelines are
not read or utilized. 33 This fact argues in favour of the
creation of several specialized wound healing units in
Norway. A rapid referral of ulcer patients to specialists
will undoubtedly raise the standards in the diagnosis and
treatment of non-healing ulcers and reduce the use of
antibiotics.
The primary message
All non-healing ulcers will be influenced to various degrees by
bacteria. There is therefore no reason to take routine bacteria
samples from chronic ulcers. It is most important to find out
the underlying cause of the ulcer and focus on its treatment.
Table 1 provides an overview of the indications for antibiotic
treatment of non-healing ulcers. In such situations, bacteria
samples should be taken from the ulcer. In most cases, empirical
treatment will be necessary and narrow-spectrum antibiotics
should be utilized to the greatest possible degree. The knowledge
of the bacterial flora in different types of non-healing ulcers is
therefore highly decisive. The treatment may have to be adjusted
when resistance is determined.
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EWMA Journal 2014 vol 14 no 1