Comparison of Silver Sulfadiazine 1% with Chlorhexidine Digluconate 0.2% to Silver Sulfadiazine 1% Alone in the Prophylactic Topical Antibacterial Treatment of Burns

Snelling, Charles F. T.; Inman, Richard J.; Eva, Gudumac; Boyle, James C.; Foley, Brian S.; Kester, David; Fitzpatrick, Donald J.; Warren, Richard; Courtemanche, A D

doi:10.1097/00004630-199101000-00004

Cited by 22 publications

(8 citation statements)

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“…Mafenide reduced the number of viable subeschar S. aureus 100‐fold below the level of silver sulfadiazine [24]resulting in a calculated killing efficiency of 99.6%. The use of mafenide is associated with severe disturbance of electrolyte balance and acidosis and therefore its clinical use is limited [4, 24–26]. In comparison, the porphyrin complex had a killing efficiency of 99.97% after a single administration, one order of magnitude more than mafenide, and it continued to exert its effect for almost 24 h.…”

Section: Discussionmentioning

confidence: 99%

The use of porphyrins for eradication ofStaphylococcus aureusin burn wound infections

Orenstein

Klein

Kopolovic

et al. 1997

FEMS Immunol Med Microbiol

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The assessment of deuteroporphyrin-hemin complex as an agent for the treatment of burn wounds infected with a multiple-drug resistant strain of Staphylococcus aureus was performed. The effect of the porphyrin on the survival of the infectious bacteria was first assayed in culture, and later tested as well in a burned infected animal model. The addition of deuteroporphyrin and hemin, separately or together (as a complex) to a growing culture of S. aureus was monitored during 8 hours. It was found that deuteroporphyrin alone was strongly bactericidal only after photosensitization. On the other hand, hemin alone was moderately bactericidal but light independent. A combination of both deuteroporphyrin and hemin was extremely potent even in the dark and did not require illumination to eradicate the bacteria. The in vivo experiments by application of the above porphyrins in combination to infected burn wounds in guinea pigs was an effective way to reduce dramatically the contaminating S. aureus. Reduction of more than 99% of the viable bacteria was noted after the porphyrin mixture was dropped on the eschar or injected into the eschar, an effect that lasted for up to 24 hours. The deuteroporphyrin-hemin complex may be suggested as a new bactericidal treatment of S. aureus infected burns since it was found to be a potent and promising anti-Staphylococcal agent.

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Section: Discussionmentioning

confidence: 99%

The use of porphyrins for eradication ofStaphylococcus aureusin burn wound infections

Orenstein

Klein

Kopolovic

et al. 1997

FEMS Immunol Med Microbiol

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“…Tulle gras dressings were particularly popular in Italy and most units using them excised the burn wound early. Silver sulphadiazine is effective in limiting colonisation by Pseudomonas aeruginosa and reducing graft failure in moderate burns [19,28]. Pseudomonas infection and colonisation have declined since silver sulphadiazine was introduced [12].…”

Section: Discussionmentioning

confidence: 99%

Wound management in burn centres in Europe

et al. 1995

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Infection remains a common cause of death in burned patients. A recent survey of UK burns units showed a range of opinion on the timing of burn wound excision and the use of therapeutic and prophylactic antibiotics. The same questionnaire was sent to other European burns units to assess their practice. Answers were obtained from 96 of the 164 units contacted. A written policy on antibiotic treatment was used by 35 (36%) units, imipenem being the single most popular antibiotic, but courses often lasted more than 10 days. Excisions were covered routinely by prophylactic antibiotics in 44 (45%) units, and 10 of these covered all procedures where the wound was manipulated. All units took surface swab cultures, and 26 (27%) took punch biopsies of the wounds. Silver sulphadiazine was used in 66 (69%) of the units while others preferred sulfamylon, povidone iodine or flamacerium. In 40 hospitals (42%) reporting proven cases of toxic shock syndrome, the median number was only six cases in two years. Nineteen (20%) excised burns within 48 hours of admission. The use of very broad spectrum antibiotics for prolonged courses was the most marked difference from the UK.

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“… Regarding the effectiveness of disinfectants for burns, there is one RCT comparing silver sulfadiazine alone and silver sulfadiazine plus chlorhexidine, and the evidence level is II. The frequency of colonization of S. aureus at the wound has been shown to be reduced, but the recommendation level was set at C1, because whether or not the treatment improves the outcome is unclear. There are various opinions and reports concerning disinfection of burns, and the matter still remains controversial.…”

Section: Disinfection Cq18: Is Disinfection Useful For the Preventionmentioning

confidence: 99%

“…Snelling et al studied 253 burn patients with a mean burned area of approximately 20% TBSA and reported that the frequency of colonization of S. aureus was reduced by washing the wounds with a mixture of silver sulfadiazine and 0.2% chlorhexidine gluconate or soap containing 4% chlorhexidine gluconate at gauze changes compared with topical application of 1% silver sulfadiazine alone. 112 As for povidone iodine, there is a report that it is toxic to fibroblasts and epidermal keratinized cells in vitro at clinically used concentrations, 120 but there is another report that no significant difference was observed in the time until cure when split-thickness mesh skin grafts were treated by topical application of povidone iodine or petrolatum. 121 However, caution is necessary in applying povidone iodine over an extensive area in patients with kidney or thyroid dysfunction or elderly patients because of its absorption from the wound surface (iodine poisoning).…”

Section: Disinfection Cq18: Is Disinfection Useful For the Preventionmentioning

confidence: 99%

The wound/burn guidelines – 6: Guidelines for the management of burns

Yoshino

Ohtsuka

Kawaguchi

et al. 2016

The Journal of Dermatology

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Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.

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Comparison of Silver Sulfadiazine 1% with Chlorhexidine Digluconate 0.2% to Silver Sulfadiazine 1% Alone in the Prophylactic Topical Antibacterial Treatment of Burns

Cited by 22 publications

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The use of porphyrins for eradication ofStaphylococcus aureusin burn wound infections

The use of porphyrins for eradication ofStaphylococcus aureusin burn wound infections

Wound management in burn centres in Europe

The wound/burn guidelines – 6: Guidelines for the management of burns

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