Chronic leg and foot
wounds represent an increasing burden to healthcare systems as the age of the population increases. The deep dermal tissues of all chronic
wounds harbour microorganisms, however, the precise interaction between microbes in the
wounds and impaired healing is unknown. With regard to
antibiotic therapy, there is a lack of evidence concerning its effectiveness, optimal regimens or clinical indications for treatment. Despite this lack of evidence,
antibiotics are frequently a feature of the management of chronic
wounds and these patients receive significantly more
antibiotic prescriptions (both systemic and topical) than age and sex-matched patients. Current guidelines for
antibiotic prescribing for such
wounds are often based on expert opinion rather than scientific fact and may present difficulties in interpretation and implementation to the clinician. Although the increasing prevalence of antibiotic resistance is widely recognized, the relationships between antibiotic resistance, chronic
wound microbiology and rationales for
antibiotic therapy have yet to be determined. This review discusses the role of microbes in chronic
wounds from a clinical perspective with particular focus on the occurrence of bacteria and their impact on such
wounds. The evidence and role of
antibiotics in the treatment of such
wounds are outlined and current practice of
antibiotic usage for chronic
wounds in the primary care setting described. The implications of
antibiotic usage with regard to antibiotic resistance are also considered.