Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns

Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization by Staphylococcus aureus was less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization by Enterococcus faecalis, Pseudomonas aeruginosa, or Enterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization by S. aureus (35% versus 51%, p = 0.03) and P. aeruginosa (8% versus 16%, p = 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization by S. aureus.     

Minor burns: treatment using a new drug delivery system with silver sulfadiazine

We investigated a new product for treatment of burn wounds in outpatients. The product is a drug delivery system composed of polyethylene glycol 400, poly-2-hydroxyethyl methacrylate, and dimethyl sulfoxide into which silver sulfadiazine is incorporated for sustained release. It is applied to the wound and changed every four to five days until the wound has epithelialized. Of the 20 patients we treated by this method, none had wound infections. Most patients had partial-thickness injuries that epithelialized without difficulty. One patient with full-thickness injuries required subsequent excision and grafting. Application of the product over joint surfaces facilitated range of motion. The product was easy to apply, it diminished pain, and it produced no abnormal effects except for an occasional bad odor.     

Comparison of purified olive oil and silver sulfadiazine in the treatment of partial thickness porcine burns

Introduction

Burns are widespread in the developed world, and expensive burn dressings are not universally available. Most burn patients suffer from a partial thickness burn that can be treated conservatively. Nevertheless, the ideal dressing for the burn wound has not been identified. We performed an animal experiment to compare the healing of partial thickness burns treated with silver sulfadiazine (SSD) and olive oil.

Methods

A randomized controlled animal experiment was conducted on 3 anesthetized domestic pigs in which 51 partial thickness burns were created using a metal bar heated to 400°C and applied to the dorsum of the animals for 20 seconds. The burns were treated every other day with SSD cream (n = 16), purified olive oil (n = 20), or no topical therapy at all (n = 15). Assessment of wound healing was done by drawing and scanning the margins of the wound at the endpoint of the experiment. The remaining open wound area was then calculated using Scion Image version beta 4.0.2 (Scion, Frederick, Md), and the results were analyzed using a 1-way ANOVA test.

Results

Burns treated with SSD healed faster than control burns (P < .05). There were no differences in the healing rates of wounds treated with olive oil versus controls or SSD. There were no wound infections in any of the 3 study groups.

Conclusions

Treatment of partial thickness burns with purified olive oil did not result in faster healing when compared with SSD or dry gauze in a porcine model.     

Morphine-Infused silver sulfadiazine (MISS) cream for burn analgesia: a pilot study

Pain is considered the most distressing symptom of a burn wound, with analgesia usually provided via oral or parenteral medications. Use of systemic opioids can be complicated by fluctuations in bioavailability, absorption, and clearance of drugs caused by the burn. There has been little research done in the area of topical medications for burn analgesia. The following is a double-blind, placebo-controlled pilot study assessing the safety (side effects) and efficacy (pain ratings and medications administered) of morphine-infused silver sulfadiazine cream for burn pain. Four patients are reported on (2 in each group). Only participants taking placebo reported side effects related to morphine and necessitated anxiolytic medications. Pain ratings in the treatment group ranged from 0 to 7 with a mean of 2.1, whereas the placebo group's ratings ranged from 2 to 8 with a mean of 5.6. The placebo group averaged 55.3 mg oral morphine per half day, whereas the treatment group averaged 42.9 mg.     

Leukopenia in non-septic burn patients receiving topical 1% silver sulfadiazine cream therapy: a survey

The cause of early postburn leukopenia (EPBL) is unknown. The evidence suggests that treating burn wounds with 1% silver sulfadiazine cream (SSD) is contributory, but that other factors exist, possibly including burn stress. Differences of opinion exist as to whether SSD applications to the wounds of non-septic burn patients should be discontinued if EPBL develops. A survey of opinion in 101 North American burn treatment facilities and a review of the literature show a strengthening of the perception that EPBL, whether caused by SSD or not, holds little risk for the burn patient. The majority of burn patients are now being assigned to treatment strategies in which the onset of EPBL requires discontinuance of SSD only at WBC counts lower than 2,000/cu mm or not at all. This is significantly lower (p less than .02) than the mean of the values recorded in the literature. There is now substantial experience with continuing the SSD therapy in this setting regardless of the WBC count. No complications are reported therefrom.     

Combined topical use of silver sulfadiazine and antibiotics as a possible solution to bacterial resistance in burn wounds

The superior efficacy of quinolones (norfloxacin, pefloxacin, and enoxacin) in controlling burn wound infections signals the discovery of new topical agents. However, there are a few reports on the emergence of resistant mutants to quinolones. Since attempts to develop AgSD resistant strains in vitro were unsuccessful and the emergence of AgSD resistance in vivo is a rare occurrence, we decided to investigate if the combined use of AgSD with other effective antibiotics, especially quinolones, would minimize the development of resistant bacteria. Our in vitro results indicate that when Ps. aeruginosa cultures were serially transferred 10 times through subinhibitory concentrations of norfloxacin, pefloxacin, etc., the MIC increased 40 times while when the cultures were passed through a combination of AgSD and these quinolones, the MIC of quinolones increased only tenfold. In vivo, when burned mice infected with either AgSD sensitive or resistant Ps. aeruginosa strains were treated with a topical cream containing 10mM silver sulfadiazine and 5mM norfloxacin or 5mM pefloxacin, the mortality was much lower than that of 10mM silver sulfadiazine alone or 5mM quinolones alone. Thus, combined use of silver sulfadiazine and quinolones appears to diminish the ability of Ps. aeruginosa strains to form resistant mutants. Furthermore, when the combination is used as a topical agent in burn wounds, lesser amounts of the individual drug are needed to control infection thereby reducing the toxic effects, if any, associated with these drugs. This combination does not in any way interfere with the antifungal or antibacterial properties of these individual drugs.     

纳米银与磺胺嘧啶银治疗烧伤创面疗效比较的Meta分析

背景:国内外应用纳米银治疗烧伤创面较为广泛,但临床研究报道多为小样本随机对照研究,缺乏循证医学方面的依据和说服力。目的:对纳米银与磺胺嘧啶银治疗烧伤创面疗效进行系统评价。方法:计算机检索PubMed、Sciencedirect(SD)数据库、重庆维普中文科技期刊全文数据库(VIP,1989/2010)和清华同方数据库(CNKI,1979/2010),收集有纳米银制剂治疗烧伤与磺胺嘧啶银治疗相比较的随机对照实验。评价纳入研究的方法学质量并进行资料提取后,采用RevMan5.1软件进行Meta分析。结果与结论:共纳入8个随机对照实验,包括513例Ⅱ度烧伤患者。Meta分析结果显示:创面愈合时间纳米银治疗组少于磺胺嘧啶银组(P<0.001);第15天创面愈合率纳米治疗组与对照组差异无显著性意义,结果为(MD=7.10,95%CI=-2.29~16.50,P=0.14);纳米银治疗组和磺胺嘧啶银组相比,在减少烧伤创面疼痛方面两者差异有显著性意义(P<0.00001)。提示应用纳米银与应用磺胺嘧啶银相比能明显促进烧伤创面的愈合,对缓解创面疼痛程度优势明显,但尚需大样本高质量随机对照研究去进一步证实。     

Traumatic injuries: office treatment of minor burns.

While minor burns are not life threatening, they may result in significant morbidity, such as loss of function, prolonged healing time, and scarring. Proper office care is mandatory if such complications are to be prevented.     

Sildimac: a new delivery system for silver sulfadiazine in the treatment of full-thickness burn injuries

Wound care is painful for the patient with a burn injury and tedious for the burn unit staff but necessary to remove exudates and debris and to limit infections. In an effort to circumvent daily dressing changes while ensuring optimal wound protection, Sildimac (Marion Laboratories, Kansas City, Mo.), a new drug delivery system for silver sulfadiazine, was developed. When silver sulfadiazine, a topical antimicrobial commonly used for the treatment of burns, is incorporated into the delivery system, the drug is released in a sustained fashion. We report here the results of a multicenter evaluation of the safety and efficiency of Sildimac for treatment of full-thickness burn wounds. Sildimac, when left in place for up to 4 days, appears to be as effective as twice-daily wound cleansing and application of Silvadene cream 1% (Marion Laboratories, Kansas City, Mo.) for the treatment of full-thickness burns.     

Cantharis in the early treatment of minor burns.

The analgesic action of the homeopathic preparation Cantharis in the treatment of minor burns was assessed in a series of 34 patients. Under double blind conditions no statistically significant difference was found between Cantharis and a placebo.     

Formaldehyde as an alternative to antibiotics for treatment of refractory impetigo and other infectious skin diseases

ABSTRACT

Introduction: Antibiotic-resistant strains of bacteria are an increasing problem in hospitals and in the community. This has resulted in bacterial infections such as impetigo becoming difficult to treat. Alternative treatment options are needed.

Areas covered: In this paper, a past study that assessed the health burden of scabies in North Queensland is described and from it, the potential for formaldehyde as an alternative antimicrobial treatment is discussed. In doing so, antibiotic resistance, impetigo, permethrin, and formaldehyde are introduced and the current understanding and limitations of the effects of formaldehyde on humans are outlined. The limited cases of formaldehyde resistance in bacteria are also discussed.

Expert opinion: Formaldehyde is currently used as a preservative in cosmetics and medicinal creams due to its antibacterial activity. It, therefore, has the potential to be used as an alternative antibacterial treatment for infections with antibiotic-resistant bacteria. The harmful side effects of airborne formaldehyde and exposure in allergic individuals have been extensively studied. Significantly less research has been conducted on formaldehyde skin contact in healthy individuals. If formaldehyde is safe for topical use in humans, it has the potential to assist with combating antibiotic resistance.     

Internally coated endotracheal tubes with silver sulfadiazine in polyurethane to prevent bacterial colonization: a clinical trial

OBJECTIVE: Coated medical devices have been shown to reduce catheter-related infections. We coated endotracheal tubes (ETT) with silver sulfadiazine (SSD), and tested them in a clinical study to assess the feasibility, safety, and efficacy of preventing bacterial colonization. DESIGN: A prospective, randomized clinical trial, phase I-II. SETTING: Academic intensive care unit (ICU). PARTICIPANTS: Forty-six adult patients expected to need 12-24 h of intubation were randomized into two groups. INTERVENTIONS: Patients were randomized to be intubated with a standard non-coated ETT (St-ETT, n=23; control group), or with a SSD-coated ETT (SSD-ETT, n=23). MEASUREMENTS AND RESULTS: Coating with SSD prevented bacterial colonization of the ETT (frequency of colonization: SSD-ETT 0/23, St-ETT 8/23; p<0.01). No organized bacterial biofilm could be identified on the lumen of any ETT; however, SSD was associated with a thinner mucus layer (in the SSD-ETT secretion deposits ranged from 0 to 200 microm; in the St-ETT deposits ranged between 50 and 700 microm). No difference was observed between the two groups in the tracheobronchial brush samples (frequency of colonization: SSD-ETT 0/23, St-ETT 2/23; p=0.48). No adverse reactions were observed with the implementation of the novel device. CONCLUSION: SSD-ETT can be safely used in preventing bacterial colonization and narrowing of the ETT in patients intubated for up to 24 h (mean intubation time 16 h).     

Phosphorus burns: a practical approach to local treatment

Most phosphorus burns are of limited extent. First aid consists of vigorous irrigation with water or saline followed by application of soaked dressings. At the Rambam Medical Center Burn Unit, washing of the wounds with 1% copper sulfate and 5% sodium bicarbonate solutions occurs before removal of phosphorus particles. In selected patients, prompt excision of the injured tissue and skin grafting are recommended. Fluid replacement and close monitoring of ECG, serum calcium, phosphorus, and electrolytes are recommended for all patients with such burns.     

Comparison of a modified hydrocortisone/urea cream and betamethasone valerate cream in the treatment of dry eczema

A half-sided, single-blind, comparative study of a new modified formulation of 1% hydrocortisone/10% urea and 0.1% betamethasone valerate cream in the treatment of dry eczema showed that the two products were equally effective at the end of 1, 2 and 3 weeks of treatment in terms of efficacy and speed of action. No statistically significant differences could be detected between either preparation in any of the trial's measures (i.e. overall severity score, dryness/scaling, erythema, papules, itching, excoriation or lichenification) at any of the weekly assessments. The incidence of side-effects was the same with both treatments and patients' preference was equally divided between the two creams.