Summary of findings 2. Topical antimicrobial agents (non‐dressing) compared with non‐antimicrobial topical agents (non‐dressing).

Topical antimicrobial agents (non‐dressing) compared with non‐antimicrobial topical agents (non‐dressing)
Patient or population: Foot ulcers in people with diabetes Setting: Mixed Intervention: Topical antimicrobial agent Comparison: Non‐antimicrobial treatment
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with non‐antimicrobial treatment	Risk with topical antimicrobial treatment
Proportion of wounds healed Up to 24 weeks' follow‐up	241 per 1000	679 per 1000 (135 to 1000)	RR 2.82 (0.56 to 14.23)	112 participants (3 studies)	⊕⊝⊝⊝ very low1	The average effect of antimicrobial agents compared with non‐antimicrobial treatment is uncertain over a medium‐term follow‐up period.
	Risk difference: 438 more healed wounds per 1000 (106 fewer to 1000 more)
Incidence of infection	Not reported for this comparison		N/A	N/A	N/A	This outcome was not reported for this comparison.
Resolution of infection Up to 24 weeks' follow‐up	368 per 1000	427 per 1000 (199 to 925)	RR 1.16 (0.54 to 2.51)	40 participants (1 study)	⊕⊕⊝⊝ low2	It is unclear whether use of an antimicrobial topical agent has an effect on risk of infection over a medium‐term follow‐up period.
	Risk difference: 59 more resolved infections per 1000 (169 fewer to 556 more)
Adverse events Up to 24 weeks' follow‐up	Not estimable		N/A	81 participants (2 studies)	⊕⊝⊝⊝ very low	2 studies reported adverse event data. We were unable to extract per‐participant data for 1 study. The second study stated that no adverse events were reported in each arm. We judged this as very low‐certainty evidence.
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; N/A: not applicable; RR: risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

¹Downgraded twice for risk of bias with two studies at high risk of detection bias, which is of particular concern when healing is being assessed, and one study not accounting for a small number of participants with multiple ulcers in their trial. Downgraded twice for imprecision: small sample size and small number of events. Downgraded once for inconsistency: one small study reported all wounds healed in one arm and few wounds healed in the other. These data are adding heterogeneity to the analysis.
 ²Downgraded twice for imprecision: small sample size and small number of events.