Infected wounds:  alternatives to antibiotics

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Manage infected wounds covering all stages of the wound infection continuum 

A common complication of wounds (and chronic wounds in particular) are infections. Wound infections compromise the normal healing process and may lead to a reduction in the patients’ quality of life. Even worse, they bear the risk of amputation and lethal sepsis. Additionally, as if losing a limb or a patient's life is not enough, wound infections provide a great burden to the health care system.

The wound infection continuum2) describes the different stages of how microbes impact a wound and consequently shows when antimicrobials are indicated and when not. This helps wound care practitioners to find the best strategy to prevent, diagnose and manage wound infections.

Get to know our unique therapy concept combining biofilm management with broad antimicrobial effectiveness1) that covers all stages of the wound infection continuum: Prontosan® to prevent the formation of biofilm and to decrease the bacterial burden3) , and Askina® Calgitrol® to manage wound infection.

Adapted from: International Wound Infection Institute (IWII) Wound infection in clinical practice. Wounds International 2016
Adapted from International Wound Infection Institute2)

Prontosan® - Wound bed preparation taken seriously

Wound infections are caused by the deposit and profileration of microorganisms in the surgical site of a susceptible host. There are numerous ways microorganisms can enter the wound bed. The infection can result in sepsis when bacteria spreads into the blood stream. If not actively treated, a sepsis can progress to multi-organ failures with a potentially lethal outcome.

The main objective is to prevent infections rather than to treat them. Learn more about wound bed preparation.

Askina® Calgitrol® - Managing wound infection

The treatment of local infection is essential for the healing process. Silver Alginates react immediately and are highly efficient against a wide range of microorganisms. Our unique silver dressings play an important role in reducing the bacterial load.

Due to its specific and patented ionic silver alginate matrix, Askina® Calgitrol® provides a broad antimicrobial effectiveness.(1) In contact with wound exudate, the alginate matrix forms a soft gel allowing a sustained controlled release to the wound bed during use of the dressing.(5) Learn more about Askina® Calgitrol® silver dressings.

Case report: The use of Prontosan® in combination with Askina® Calgitrol®

Naude L. The use of Prontosan® in combination of Askina® Calgitrol®: an independent case series. Wounds International, 2018 ; 9(1): 44-48.  Available at  (accessed 16.03.2018).
Go to the study.

An independent case series6)

The following case studies were carried out to evaluate the efficacy of a biofilm remover/cleanser in gel form - Prontosan® together with the use of an ionic releasing silver alginate - Askina® Calgitrol® Paste or Askina® Calgitrol® Thin - when used on infected wounds.

Treatment protocol

The following treatment protocol was followed for all wounds in the study:

  • Wounds were soaked for 15–20 minutes with Prontosan® gel or Prontosan® irrigation solution moistened gauze. Both the gel and the soaked gauze was kept in place by using cling film, gel was wiped away with saline gauze and soaked Prontosan gauze was used to wipe the wound
  • After wound cleansing, Calgitrol® Thin or Calgitrol® paste was applied depending on wound size and depth
  • The secondary dressing applied varied from non-adhesive foam to high-absorbent composite dressing depending on exudate levels

Results: Infection resolve time

All wounds showed a signi cant reduction in terms of clinical signs of infection within the first week of treatment. Some 50% of all wound infections were completely resolved by week 2. Eighty-one per cent of all wounds had no clinical signs of infection in less than 3 weeks. None of the patients were given any oral orintravenous antibiotics while on the study; all patients were only treated by using local antimicrobials. There was also a decrease in odour in all wounds.

Read the complete case report. 

Antimicrobial resistance and misuse of antibiotics

Antimicrobial resistance (AMR) develops when microbes adapt and build immunity against antimicrobial drugs such as antibiotics. Over- and misuse of antibiotics increase this problem and present a serious health threat, since infections with antibiotic-resistant bacteria are associated with longer hospital stays and higher death rates. Antimicrobial resistant infections currently cause at least 50,000 deaths across Europe each year.7) And estimates are that by 2050 antimicrobial resistance will account for 10 million deaths worldwide per year, leading to annual global costs of US$100 trillion.7)

Read also 'The Antibiotic Crisis'. 

AMR is a worldwide problem involving multiple sectors that is being addressed from different angles. The key strategy of this battle against the rise of antimicrobial resistance and healthcare-associated preventable infections is the adoption of local and national antimicrobial stewardship programs facilitating more prudent prescribing of antibiotics.  

Antimicrobial stewardship

Regarding wound management, it is the European Wound Management Association (EWMA) which has taken the lead in introducing a tailored stewardship concept to wound care practitioners. The aim of this  Antimicrobial Stewardship program, which B.  Braun is proud to sponsor, is to reduce the inappropriate use of antibiotics in wound care by promoting the use of non-antibiotic antimicrobials across all healthcare settings.8) One of these alternatives is Askina® Calgitrol®, which provides broad-spectrum antimicrobial activity for acute or chronic wounds with, or at risk of, a high level of bioburden or local infection.

Did you know?

Did you know?


90% of chronic wounds contain biofilm with a role in wound infection(11).


50% of chronic wounds are estimated to be infected(12).

Brochures & Clinical Evidences

Description Document Link
Prevention and treatment of infections Prontosan® and Askina® Calgitrol® - Product brochure
pdf (3.8 MB)
Case Studies Askina® Calgitrol® Askina® Calgitrol® Ag, Askina® Calgitrol® THIN and Askina® Calgitrol® Paste - Reports of treatment successes (photo storyboard).
pdf (4.9 MB)
Case report: The use of Prontosan® in combination with Askina® Calgitrol® Liezl Naude; Wounds International 2018 ;Vol 9 Issue 1
pdf (2.3 MB)


1) Instruction for use: Askina® Calgitrol® Ag, Askina® Calgitrol® THIN, Askina® Calgitrol® Paste.

2) International Wound Infection Institute (IWII). Wound infection in clinical practice. Wounds International 2016.

3) To, E The effectivness of PHMB agents for the treatment of chronic wounds: A systematic review, Advance wound healing, 2016.

4) Moore, M 0.1% Polyhexanide-Betaine Solution as an Adjuvant in a Case-Series of Chronic Wounds, Surg Technology International, 2016.1) Instruction for use: Askina® Calgitrol® Ag, Askina® Calgitrol® THIN, Askina® Calgitrol® Paste.

5) Opasanon S, Magnette A, Meuleniere F, Harding K. Askina® Calgitrol® Made Easy. Wounds International 2012; 3(1). Available from

6) Naude L. The use of Prontosan® in combination of Askina® Calgitrol®: an independent case series. Wounds International, 2018 ; 9(1): 44-48.  Available at  (accessed 16.03.2018).

7) Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. Review on AMR, Wellcome Trust, HM Government, 2014. Available at: (accessed 31.03.2017)


9) Dolk FC, Pouwels KB, Smith DR et al. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother 2018;73:ii2–10.

10) Oien RF, Forssell HW. Ulcer healing time and antibiotic treatment before and after the introduction of the Registry of Ulcer Treatment: an improvement project in a national quality registry in Sweden. BMJ Open. 2013;3(8):e003091. Published 2013 Aug 19. doi:10.1136/bmjopen-2013-003091

11) Attinger C, Wolcott R. Clinically Addressing Biofilm in Chronic Wounds. Adv Wound Care (New Rochelle). 2012 Jun;1(3):127-132. doi: 10.1089/wound.2011.0333.

12) C. Dowsett: Adopting the two-week challenge in practice: making the case for silver dressings, Wounds UK, Vol. 10, N°2, 2014