Antimicrobial wound management products
Antimicrobials are agents which kill or inhibit the growth and division of micro-organisms. Indiscriminate use of antimicrobial wound dressings should be discouraged because of concerns over bacterial resistance and toxicity. See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
Products with a ‘Specialist Initiation’ flag should be initiated on the advice of the relevant specialist (e.g. Tissue Viability, Podiatry, Vascular, Plastic Surgery or Dermatology).
Additional information on products, including contraindications, can be found in the Journal of Wound Care’s Wound Care Handbook. Colleagues in NHS Lothian can access supporting materials on the Tissue Viability pages of the Lothian intranet.
Scottish Ropper Ladder JWC Wound Care Handbook Scottish Drug Tariff
Flaminal Hydro (15g, 50g) – Enzymatic alginate gel for low to moderate exuding wounds.
Flaminal Forte (15g, 50g) – Enzymatic alginate gel for moderate to high exuding wounds.
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- Antimicrobial dressings are appropriate for critically colonised or locally infected wounds.
- All antimicrobial dressings should be used in line with antimicrobial stewardship and must be considered for discontinuation after each 14 day period.
- Systemic antibiotics are indicated in case of spreading infection where the classic signs are evident.
- Flaminal Forte should be used in wounds that have moderate to heavy amounts of exudates. An appropriate secondary dressing for the amount of exudates should be chosen. The dressing can stay in place for as long as the gel structure is intact (1-4 days, depending on amount of exudate).
- Flaminal Hydro is suitable for dry to low exudating wounds.
- Flaminal Forte contains alginate polymers and an antimicrobial enzymatic complex.
- Tubes of Flaminal Forte can be recapped, once open and used on the same patient until the expiry on the pack.
- If using prior to larvae therapy, please ensure Flaminal is fully removed by cleansing.
History Notes
29/03/2023
Updates to notes - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.
Ointment dressing – L-Mesitran (20g, 50g). Antibacterial ointment with 48% medical-grade honey.
Tulle dressing – Actilite. Viscose net dressing coated with manuka honey and manuka oil (ratio of 99% honey to 1% oil).
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- Antimicrobial dressings are appropriate for critically colonised or locally infected wounds.
- All antimicrobial dressings should be used in line with antimicrobial stewardship and must be considered for discontinuation after each 14 day period.
- Systemic antibiotics are indicated in case of spreading infection where the classic signs are evident.
- Honey is an antimicrobial that can also promote autolysis of necrotic or sloughy tissue.
- Increased exudate can be expected for up to 48 hours after first application therefore appropriate secondary dressing is required. Patients may experience a drawing sensation/pain due to the osmotic action of the honey.
- Blood sugar levels should be monitored as normal in diabetic patients.
- Honey dressings also have deodorising properties.
History Notes
10/09/2025
Updated prescribing information, ERWG August 2025
29/03/2023
Updates to products and supporting notes - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.
Sterile povidone-iodine fabric dressing. Very frequent dressing changes required due to deactivation on exudate contact.
Iodoflex paste dressing (5g, 10g, 17g) – iodine 0.9% as cadexomer-iodine in a paste basis with gauze backing.
Apply to wound surface, remove gauze backing and cover; renew when saturated (usually 2-3 times weekly, daily for heavily exuding wounds).
Iodosorb ointment dressing (10g, 20g) – iodine 0.9% as cadexomer-iodine in an ointment basis.
Apply to wound surface to depth of approx. 3 mm and cover; renew when saturated (usually 2-3 times weekly, daily for heavily exuding wounds).
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- Antimicrobial dressings are appropriate for critically colonised or locally infected wounds.
- All antimicrobial dressings should be used in line with antimicrobial stewardship and must be considered for discontinuation after each 14 day period.
- Systemic antibiotics are indicated in case of spreading infection where the classic signs are evident.
- Inadine is rapidly deactivated by wound exudate.
- Absorbent iodine dressings are for moderate to heavily exudating wounds.
- Maximum dose recommended for 0.9% cadexomer-iodine, single application 50g, weekly application 150g. Maximum duration of treatment up to 3 months in any single course of treatment.
- Colour indicator for all iodine products: changes from orange/brown to white when inactive (i.e. iodine used up).
- Cadexomer-iodine 0.9% has not been shown to be toxic to newly formed tissue within a wound. Iodine >1% free can be toxic to newly formed tissue within a wound.
- Due to the possible systemic absorption of iodine products, always refer to the manufacturer's instructions for contraindications and precautions before use. For example:
- known sensitivity to iodine or any ingredient
- patients with thyroid or kidney disorders
- use on children, or in pregnancy and breastfeeding
- before and after the use of radio-iodine
History Notes
22/05/2024
Updates to prescribing notes.
29/03/2023
Updates to layout and supporting notes - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.
Sterile polyurethane foam film dressing without adhesive border for specialist use.
Antimicrobial bio-cellulose dressing for specialist use.
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- Antimicrobial dressings are appropriate for critically colonised or locally infected wounds.
- All antimicrobial dressings should be used in line with antimicrobial stewardship and must be considered for discontinuation after each 14 day period.
- Systemic antibiotics are indicated in case of spreading infection where the classic signs are evident.
- Suprasorb absorbs exudate and donates fluid, balancing moisture of the wound bed. Can be used for pain reduction.
History Notes
29/03/2023
Updated flags - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.
Silver dressings have a high cost and should not be used routinely for the management of uncomplicated wounds.
Hydrofiber antimicrobial primary dressing with silver.
Non-adherent antimicrobial alginate dressing – non-woven pad composed of alginate, carboxymethylcellulose (CMC) and silver coated nylon fibres.
Askina Calgitrol Paste (15g) – sterile primary dressing consisting of an ionic silver alginate matrix in paste form.
Non-adherent conformable dressing with silver, for specialist use in plastics.
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- Antimicrobial dressings are appropriate for critically colonised or locally infected wounds.
- All antimicrobial dressings should be used in line with antimicrobial stewardship and must be considered for discontinuation after each 14 day period.
- Systemic antibiotics are indicated in case of spreading infection where the classic signs are evident.
- Aquacel is a hydrofiber plus ionic sliver for wounds that are infected.
- Askina Calgitrol Paste is a sterile primary dressing consisting of an ionic silver alginate matrix in paste form, which provides antimicrobial properties. Once opened use within 7 days, once opened and the lid reclosed after use.
- Silvercel is a silver containing alginate dressing for infected wounds. Used for moderate to heavily exuding wounds.
History Notes
26/10/2023
Askina Calgitrol Ag removed as being discontinued.
29/03/2023
Updates to products and supporting notes - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.
Primary contact wound layer – Hydrophobic antimicrobial wound contact layer designed to bind bacteria under moist wound conditions. Can be used folded or unfolded.
Primary contact wound layer – Antimicrobial ribbon designed to bind bacteria and fungi under moist wound conditions.
Absorbent – Hydrophobic antimicrobial dressing designed to absorb exudate and bind bacteria under moist wound conditions.
Gel sheet – Cutimed Sorbact swab combined with an absorbent hydropolymer gel sheet. Designed to reduce wound bioburden, as well as absorb and lock in exudate while maintaining a moist environment.
Prescribing Notes:
- See Scottish Ropper Ladder for Infected Wounds for guidelines on identifying infected wounds and when to start and stop using topical antimicrobial wound dressings.
- DACC technology is an alternative approach to that of all other topical antimicrobials. They do not donate into the wound but instead, in a moist environment, microbes bind irreversibly to the dressing and therefore removed on dressing change.
History Notes
31/08/2023
Cutimed Sorbion Sachet S and Sachet XL moved to 'Superabsorbent dressings – without border' section.
29/03/2023
Updates to products and supporting notes - ERFC 29/03/2023.
18/01/2023
East Region Formulary content agreed.