A Prospective Analysis of Silver Sulfadiazine with and without Cerium Nitrate as a Topical Agent in the Treatment of Severely Burned Children

Bowser, Bonny H.; Caldwell, Fred T.; Cone, John B.; Eisenach, Kathleen D.; Thompson, Carolyn H.

doi:10.1097/00005373-198107000-00010

Cited by 29 publications

(7 citation statements)

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“…However, despite widespread use of silver-based products and supporting in vitro and animal model data, there is continued debate regarding clinical infection outcomes in humans, with concerns related to delayed wound healing and emerging resistance ( 32 , 33 ). This has prompted efforts to improve the antimicrobial performance of silver sulfadiazine by the addition of cerium ( 34 ), 0.2% chlorhexidine ( 35 ), and hyaluronic acid ( 36 ), with varied success. As such, there remains a need for improved topical antimicrobial therapeutics.…”

Section: Discussionmentioning

confidence: 99%

Zinc Pyrithione Improves the Antibacterial Activity of Silver Sulfadiazine Ointment

Blanchard

Brooks

Ebsworth-Mojica

et al. 2016

mSphere

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Topical antimicrobial ointments ostensibly mitigate bacterial wound disease and reliance on systemic antibiotics. Yet studies have called into question the therapeutic benefits of several traditional topical antibacterials, accentuating the need for improved next-generation antimicrobial ointments. Yet the development of such agents consisting of a new chemical entity is a time-consuming and expensive proposition. Considering that drug combinations are a mainstay therapeutic strategy for the treatment of other therapeutic indications, one alternative approach is to improve the performance of conventional antimicrobial ointments by the addition of a well-characterized and FDA-approved agent. Here we report data that indicate that the antimicrobial properties of silver sulfadiazine ointments can be significantly improved by the addition of the antifungal zinc pyrithione, suggesting that such combinations may provide an improved therapeutic option for the topical treatment of wound infections.

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Section: Discussionmentioning

confidence: 99%

Zinc Pyrithione Improves the Antibacterial Activity of Silver Sulfadiazine Ointment

Blanchard

Brooks

Ebsworth-Mojica

et al. 2016

mSphere

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“…27 However, one failed to confirm those microbial effects in both in vitro studies 28,29 and clinical survey. 30 Nevertheless, we believe that crust forming plays a very important role. 8 Indeed, unlike dry necrosis, there is no gap between wounds edges and the crust.…”

Section: Discussionmentioning

confidence: 94%

Silver Sulfadiazine and Cerium Nitrate in Ischemic Skin Necrosis of the Leg and Foot: Results of a Prospective Randomized Controlled Study

Vitse

Tchero

Meaume

et al. 2018

The International Journal of Lower Extremity Wounds

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Flammacerium is a topical treatment composed of silver sulfadiazine and cerium nitrate initially used in burns. The objective was to assess the effectiveness of silver sulfadiazine and cerium nitrate on ischemic necrosis wounds of the lower limb as an alternative to amputation for a period of 12 weeks. Patients were prospectively randomized to receive silver sulfadiazine and cerium nitrate or standard care. Patients included adults with an ischemic wound of the lower limb, with necrosis covering over at least 50%. Critical ischemia limb was confirmed by an ankle-brachial index <0.7 or >1.3 with radiological confirmation. Patient demographic data, amputations procedures, wound area, Visual Analogue Scale pain rating, clinical infection, and adverse events were recorded. Fifty patients, 34 males and 16 females, were recruited between January 2010 and April 2014, 25 in each group. The mean age was 75.14 years (±11.64). Nine amputations (36%) occurred in each group. Amputation-free survival was superior in the active treatment group versus the standard group (169 393 days, 95% confidence interval = 134.926-203.861, vs 169 393 days, 95% confidence interval = 134.926-203.861). It was not statistically significant (log-rank, P = .958). Wound area reduction between both groups was not statistically different ( P = .651). Less adverse events of the lower limb occurred in the active treatment group ( P = .001). Our study showed that silver sulfadiazine and cerium nitrate is not inferior to standardized care on ischemic necrotic wounds of the lower extremity. Further studies are still needed to confirm its effectiveness.

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“…The addition of cerium was purported to increase activity against gram-negative bacteria, although several studies comparing the two compounds failed to demonstrate direct benefit [26][27][28]. One study showed a reduced time to re-epithelialization or grafting and overall shorter hospital stays in patients treated with the cerium-SSD combination [29].…”

Section: Topical Application For Burnsmentioning

confidence: 99%

Use of Silver in the Prevention and Treatment of Infections: Silver Review

Politano

Campbell

Rosenberger

et al. 2013

Surgical Infections

167

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Background: The use of silver for the treatment of various maladies or to prevent the transmission of infection dates back to at least 4000 b.c.e. Medical applications are documented in the literature throughout the 17th and 18th centuries. The bactericidal activity of silver is well established. Silver nitrate was used topically throughout the 1800s for the treatment of burns, ulcerations, and infected wounds, and although its use declined after World War II and the advent of antibiotics, Fox revitalized its use in the form of silver sulfadiazine in 1968. Method: Review of the pertinent English-language literature. Results: Since Fox's work, the use of topical silver to reduce bacterial burden and promote healing has been investigated in the setting of chronic wounds and ulcers, post-operative incision dressings, blood and urinary catheter designs, endotracheal tubes, orthopedic devices, vascular prostheses, and the sewing ring of prosthetic heart valves. The beneficial effects of silver in reducing or preventing infection have been seen in the topical treatment of burns and chronic wounds and in its use as a coating for many medical devices. However, silver has been unsuccessful in certain applications, such as the Silzone heart valve. In other settings, such as orthopedic hardware coatings, its benefit remains unproved. Conclusion: Silver remains a reasonable addition to the armamentarium against infection and has relatively few side effects. However, one should weigh the benefits of silver-containing products against the known side effects and the other options available for the intended purpose when selecting the most appropriate therapy.

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A Prospective Analysis of Silver Sulfadiazine with and without Cerium Nitrate as a Topical Agent in the Treatment of Severely Burned Children

Cited by 29 publications

References 0 publications

Zinc Pyrithione Improves the Antibacterial Activity of Silver Sulfadiazine Ointment

Zinc Pyrithione Improves the Antibacterial Activity of Silver Sulfadiazine Ointment

Silver Sulfadiazine and Cerium Nitrate in Ischemic Skin Necrosis of the Leg and Foot: Results of a Prospective Randomized Controlled Study

Use of Silver in the Prevention and Treatment of Infections: Silver Review

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