Topical Antimicrobial — Pseudomonas
Pregnancy: Safe for topical use
Acetic Acid 0.5–1% Solution
Brand names: Acetic Acid Irrigation Solution
Adult dose
Dose: Irrigate or soak wound with 0.5–1% solution for 10–20 minutes; or apply acetic acid-soaked gauze as wet dressing
Route: Topical (wound irrigation or wet dressing)
Frequency: Once to twice daily
Max: As clinically required
Low pH (acetic acid) creates bactericidal environment specifically effective against Pseudomonas aeruginosa (characteristic blue-green wound discolouration). Used in burns and chronic wounds with clinical/microbiological evidence of Pseudomonas infection. Green discolouration of dressings is diagnostic of Pseudomonas.
Paediatric dose
Route: Topical
Frequency: Once to twice daily
Max: As clinically required
Use with caution in children — dilute to 0.5%; can cause discomfort. Seek specialist guidance for large wound areas.
Dose adjustments
Renal
No adjustment — topical use.
Hepatic
No adjustment.
Clinical pearls
- Pseudomonas produces pyocyanin (blue-green pigment) — characteristic colour on dressings is diagnostic. Acetic acid is an inexpensive, effective, evidence-based topical treatment.
- Standard white vinegar (5% acetic acid) must be diluted 1:5 to make 1% solution — used in resource-limited settings
- Combine with systemic antipseudomonal therapy (piperacillin-tazobactam, ceftazidime) for invasive burns Pseudomonas infection
Contraindications
- Hypersensitivity (rare)
- Facial wounds (irritant to mucosal surfaces)
Side effects
- Pain and burning on application
- Maceration of periwound skin
- Disruption of wound healing at high concentrations (>2%)
Interactions
- None clinically significant for topical use
Monitoring
- Wound culture sensitivity results
- Clinical signs of Pseudomonas clearance (cessation of blue-green discolouration)
- Periwound skin condition
Reference: BNFc; BNF 90; BBA Burns Wound Care Guidelines; Pseudomonas Wound Infection Guidelines (IDSA). Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators