Successful prophylaxis of gas gangrene of the high-velocity missile wound in sheep

Owen-Smith, M. S.; Matheson, J. M.

doi:10.1002/bjs.1800550111

Cited by 34 publications

(9 citation statements)

References 11 publications

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“…Current therapy involves aggressive surgical debridement, administration of hyperbaric oxygen, and penicillin treatment (8,10,12,14,21,22). Because more than one species of clostridia may be cultured from the wound and since strains other than C. perfringens are more likely to be resistant to clindamycin, cefoxitin, chloramphenicol, and tetracycline (9,10,16,26), antibiotic resistance is an important consideration (10) in selecting an antimicrobial agent.…”

mentioning

confidence: 99%

Comparison of single and combination antimicrobial agents for prevention of experimental gas gangrene caused by Clostridium perfringens

Stevens¹,

Laine²,

Mitten³

1987

Antimicrob Agents Chemother

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The treatment of experimental gas gangrene caused by Clostridium perfringens was investigated by using combinations of antimicrobial agents. This study demonstrated that rifampin, penicillin, metronidazole, and clindamycin were all bactericidal against standard inocula (105 to 106 CFU). These antimicrobial agents were then administered to mice beginning 30 min after intramuscular injection of 109 CFU of C. perfringens type A.The highest doses used produced levels of drug in blood which exceeded the MIC by at least a factor of 40. In addition, other groups of mice received monotherapy at full dose or one-fourth full dose or combination antimicrobial therapy at full or one-fourth full dose. Among the single and combination antimicrobial treatments, metronidazole alone, clindamycin alone, and clindamycin plus penicillin were the most efficacious (P < 0.05). Although the survival of mice treated with clindamycin plus penicillin was greater than that of mice treated with clindamycin alone, the difference did not reach statistical significance (P > 0.05). In contrast, mice treated with a combination of metronidazole and penicillin demonstrated greater mortality than those treated with metronidazole alone (P < 0.05). In summary, combination antimicrobial therapy of experimental C. perfringens infection did not improve survival compared to that achieved with metronidazole or clindamycin alone, and some combinations significantly reduced survival (P < 0.05).

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confidence: 99%

Comparison of single and combination antimicrobial agents for prevention of experimental gas gangrene caused by Clostridium perfringens

Stevens¹,

Laine²,

Mitten³

1987

Antimicrob Agents Chemother

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“…Previous attempts to determine the part played by antitoxin in gas-gangrene prophylaxis and therapy following war injuries have been associated with surgical or antibiotic treatment or both, except in the work described by Owen-Smith and Matheson (1968). With the experimental sheep model that we have used, these authors showed that penicillin alone was completely effective in preventing gas gangrene if given within 9 hr of wounding and challenge.…”

Section: Discussionmentioning

confidence: 97%

“…In the investigation of gas gangrene following high-velocity missile wounds, the sheep has proved to be a satisfactory experimental animal (Owen-Smith, 1968 ;Owen-Smith and Matheson, 1968). In such wounds, tissue destruction is chiefly caused by a process known as cavitation.…”

Section: N a Boyd P D Walker And R 0 Thomsonmentioning

confidence: 99%

The Prevention Of Experimental Clostridium Novyi Gas Gangrene In High-VelociTy Missile Wounds By Passive Immunisation

Boyd

Walker

Thomson

1972

Journal of Medical Microbiology

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“…15,18 Penicillin has been associated with a reduction in the morbidity and mortality of war wounds and there is strong experimental evidence to support its continued use. 15,[20][21][22] A gunshot fracture carries a risk of staphylococcal osteomyelitis, and most pathogenic staphylococci are now resistant to penicillin. For this reason additional cover is needed with flucloxacillin or a cephalosporin.…”

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confidence: 99%

Management of Gunshot Wounds of the Limbs

Bowyer

Rossiter

1997

The Journal of Bone and Joint Surgery. British volume

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The incidence of bullet wounds in civilian trauma has increased in many parts of the world, sometimes approaching epidemic level.1 For surgeons with limited experience there is a bewildering range of apparently contradictory advice on management. 2-4 An attempt to clarify this for gunshot injuries of the limbs, without major vascular injury, must include current concepts of ballistic wounding, the pathology of soft-tissue wounds and fractures, and of bacterial contamination. Advice on clinical practice and treatment options cannot be prescriptive because of the wide range of injury patterns and settings, but an understanding of the general principles can guide clinical management. WOUND BALLISTICSThe interaction of projectiles and biological targets 5 should not be considered merely in terms of the missile velocity or its available energy. The important factor is its tissue interaction: a 'high-energy' bullet may sometimes produce a low-energy transfer wound. 6Energy transfer. The available kinetic energy of a missile depends on its mass (m) and velocity (v) according to the equation E = 1/2 mv 2 , but the tissues involved and other projectile factors will determine the amount of energy which is transferred (⌬ E). The rate of energy transfer (dE/ dt) is also important; this may vary along the wound track (dE/dx) and in terms of energy flux (⌬E/cross-sectional area). These unfamiliar terms are the major determinants of the pathological effects, 3,7 and mean that wound management cannot be based on the characteristics of the weapon, be it handgun, rifle, or shotgun. The key is to "treat the wound, not the weapon". 4

show abstract

Successful prophylaxis of gas gangrene of the high-velocity missile wound in sheep

Cited by 34 publications

References 11 publications

Comparison of single and combination antimicrobial agents for prevention of experimental gas gangrene caused by Clostridium perfringens

Comparison of single and combination antimicrobial agents for prevention of experimental gas gangrene caused by Clostridium perfringens

The Prevention Of Experimental Clostridium Novyi Gas Gangrene In High-VelociTy Missile Wounds By Passive Immunisation

Management of Gunshot Wounds of the Limbs

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