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PubMed1982

Toxic epidermal necrolysis-case report and review of the literature.

A patient who developed toxic epidermal necrolysis secondary to a sulfonamide derivative is presented. Treatment consisted of fluid resuscitation and silver nitrate soaks to the affected areas. Silver nitrate was selected over silver sulfadiazine (Silvadene) and mafenide in view of the nature of the offending agent. Tissue biopsy helps in the differentiation of toxic epidermal necrolysis from staphylococcal scalded skin syndrome. A biopsy is especially useful if the offending agent is not known so that appropriate treatment can be started promptly. The mortality associated with toxic epidermal necrolysis is in the neighborhood of 30%. The priniciples of burn wound management are the key to treatment of this disease. The wound usually heals by epithelialization without the need of skin grafting.

Adult↗
PubMed1975

Suppression of leukocyte chemotaxis in vitro by chemotherapeutic agents used in the management of thermal injuries.

Polymorphonuclear leukocytes from burned patients exhibit suppressed chemotaxis possibly related to the susceptibility of such patients to opportunistic infection. This study assesses the effect of normal serum upon burn-suppressed leukocytes and the effects of three commonly used topical chemotherapeutic agents upon the chemotaxis exhibited by granulocytes from normal controls. In vitro incubation with normal serum restored chemotaxis to normal in the suppressed granulocytes from burned patients. The serum factor responsible for this restoration was heat labile. Serum albumin alone did not exhibit this effect. Both mafenide and silver sulfadiazine suppressed the chemotactic function of granulocytes obtained from normal controls, while silver nitrate exhibited no such activity. Studies of the chemotactic function of control granulocytes after incubation with sera from burned patients yielded similar results; only the sera from patients treated with silver nitrate failed to suppress normal leukotaxis. The chemotactic impairment found in leukocytes from burned patients, however, while related to burn size and predictive of prognosis, did not vary with the agent used for the topical therapy. These data suggest the presence of a reversible intrinsic defect in leukotaxis consequent to burn injury, related to some factor deficient in burn serum. In addition, extrinsic impairment of normal granulocyte leukotaxis by two commonly used chemotherapeutic agents is demonstrated.

Administration, Topical↗
PubMedDate not supplied

Susceptibility testing of topical antibacterials against methicillin-resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) isolates that were collected from 44 consecutive patients during 1 year in a community hospital were tested for susceptibility to five commonly used topical antibacterial agents. Agar-well susceptibility testing, which was based on zones of inhibition, was used to compare the effectiveness of the antibacterials against MRSA. Nitrofurazone was effective in inhibition of bacterial growth and was relatively inexpensive. Mupirocin was found to be effective but more costly for treatment of MRSA. Varying degrees of susceptibility to silver sulfadiazine, mafenide acetate, and bacitracin were noted in the cultures that were obtained at this medical center. On the basis of our findings from susceptibility tests compared with those of another center, we recommend that all hospitals undertake topical sensitivity testing of their MRSA isolates. Appropriate and effective topical antibacterial therapy can then be planned within each center.

Anti-Infective Agents, Local↗
PubMed1987

Control of burn wound sepsis: a comparison of in vitro topical antimicrobial assays.

The Minimal Inhibitory Concentration (MIC) and the Nathan's Agar Well Diffusion (NAWD) tests are bacterial antimicrobial susceptibility predictors. Some suggest that the NAWD is not as reliable as the MIC test. We compared the MIC and NAWD tests as to how well they agree to bacterial sensitivity or resistance and predicted clinical outcome of burn wound infections. Using 65 bacterial isolates from burned patients, the MIC and NAWD tests agreed in 60.0% of the isolates (vs. a perfect agreement of 100%, p less than 0.001), implying that these tests are not interchangeable. From 18 burned patients treated with nitrofurazone or mafenide acetate, 28 infectious isolates were evaluated. The outcome of these infections was correctly predicted by NAWD in 92.8% and the MIC in 72.0% of the cases (p less than 0.05). It seems that for burns treated with topical antimicrobials, the NAWD is a more reliable predictor of bacterial susceptibility.

Bacteria↗
PubMed1991

The relationship between mechanisms of wounding and principles of treatment of missile wounds.

Determinants of the wounding effects of a metallic projectile include the velocity, mass, shape, and stability of the missile, and whether it tumbles, deforms, or fragments within the body. The velocity, mass, shape, and stability influence its capability to penetrate through the skin, and the other factors influence the depth and volume of the wound. The energy lost into the tissues (kinetic energy deposition) is a greater determinant of potential wound volume than is the striking velocity, even though, because K.E. = 1/2 MV2, the potential striking K.E. is more strongly influenced by velocity than mass. The actual size and shape of the wound is influenced by tumbling, deformation, and fragmentation of the projectile and by the characteristics of the tissues and organs contacted. The pulsating temporary cavitation resulting from the passage of a high-velocity projectile produces blunt trauma that extends beyond the tissue actually contacted by the missile. The pulsation of the temporary cavitation with resulting strong negative pressure components permits contamination of the entire wound track of a perforating wound, with entrance of external contaminants from both the exit and the entrance sites. The extent and type of treatment required is determined more by the tissues and organs injured than by the characteristics of the wounding agent. Although extremity wounds from high-velocity projectiles may heal uneventfully, surgical exploration is indicated whenever there is a possibility of subfascial penetration, and obviously devascularized tissue should be excised. In circumstances in which contaminated devascularized tissue cannot be excised promptly or adequately, prophylactic topical antibacterial therapy (such as mafenide aqueous spray, which can penetrate through devascularized tissue) may prevent otherwise lethal infection.

Animals↗
PubMedDate not supplied

Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case report.

A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as Pseudomonas aeruginosa and the yeast was Candida tropicalis. On day 7, Escherichia coli was identified in blood cultures and intravenous cefixime was added. Amphotericin B was added on day 9 when blood cultures grew Candida tropicalis and Burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.

Anti-Infective Agents, Local↗
PubMed1994

Carbonic Anhydrase Activity in Isolated Chloroplasts of Wild-Type and High-CO2-Dependent Mutants of Chlamydomonas reinhardtii as Studied by a New Assay.

In an assay of carbonic anhydrase (CA), NAH14CO3 soltution at the bottom of a sealed vessel releases 14CO2, which diffuses to the top of the vessel to be assimilated by photosynthesizing Chlamydomonas reinhardtii cells that have been adapted to a low-CO2 environment. The assay is initiated by illuminating the cells and is stopped by turning the light off and killing the cells with acid. Enzyme activity was estimated from acid-stable radioactivity. With bovine CA, 1.5 Wilbur-Anderson units (WAU) was consistently measured at 5- to 6-fold above background. Sonicated whole cells of air-adapted wild-type C. reinhardtii had 740 [plus or minus] 12.4 WAU/mg chlorophyll (Chl). Sonicated chloroplasts from a mixotrophically grown wall-less strain, cw-15, had 35.5 [plus or minus] 2.6 WAU/mg Chl, whereas chloroplasts from wall-less external CA mutant strain cia5/cw-15 had 33.8 [plus or minus] 1.9 WAU/mg Chl. Sonicated chloroplasts from the wall-less mutant strain cia-3/cw-15, believed to lack an internal CA, had 2.8 [plus or minus] 3.2 WAU/mg Chl. Sonicated whole cells from cia3/cw-15 had 2.8 [plus or minus] 7.8 WAU/mg Chl. Acetazolamide, ethoxyzolamide, and p-aminomethylbenzene sulfonamide (Mafenide) at 100 [mu]M inhibited CA in sonicated chloroplasts from cia-5/cw-15. Treatment at 80[deg]C for 10 min inhibited this CA activity by 90.8 [plus or minus] 3.6%. Thus, a sensitive 14C assay has confirmed the presence of a CA in cw-15 and cia-5/cw-15 chloroplasts and the lack of a CA in cia-3/cw-15 chloroplasts. Our results indicate that HCO3- is the inorganic carbon species that is accumulated by chloroplasts of Chlamydomonas and that chloroplastic CA is responsible for the majority of internal CA activity.

Journal Article↗
PubMed1999

The use of a modified Dakin's solution (sodium hypochlorite) in the treatment of Vibrio vulnificus infection.

We report the first clinical use of a modified Dakin's solution (0.025% sodium hypochlorite [NaOCl]) to halt the progress of severe cutaneous Vibrio vulnificus infection in a critically ill patient. The regimen used arose from an initial in vitro study designed to examine the sensitivity of Vibrio species to topical antimicrobial agents. Twenty-eight wound isolates were tested against the following eight topical preparations: silver sulfadiazine (Silvadene), nitrofurazone, mupirocin ointment (Bactroban), polymyxin B/bacitracin, mafenide acetate (Sulfamylon), nystatin/Silvadene, nystatin/polymyxin B/bacitracin, and 0.025% NaOCl solution. The results showed that V vulnificus, along with the other 18 Vibrio species tested, was most sensitive to the modified NaOCl solution.

Administration, Cutaneous↗
PubMedDate not supplied

Drug kinetics in burn patients.

Thermal trauma reportedly induces a spectrum of intricate physiological alterations that often involve cardiovascular, hepatic, renal, and dermatological functions. Individual responses to varying degrees of burn and secondary complications may produce unpredictable changes in the pharmacokinetics of drugs. A number of reports describing the disposition of aminoglycoside antibiotics in burn patients have demonstrated clinially significant alterations in the pharmacokinetics of this class of drugs. Several authors have found significantly reduced serum half-lives in burn patients as compared with average values in non-burned subjects. Increased aminoglycoside clearances in some burn patients have been attributed to increased glomerular filtration secondary to elevated cardiac output, prostaglandin formation, and glucagon secretion: others attribute this to enhanced elimination of drug across damaged skin tissue. Monitoring of serum aminoglycoside concentrations is recommended because of the low therapeutic index of these agents and the variable course of renal function following burn injury. Topical application of mafenide acetate, providone iodine, and gentamicin to burn wounds has resulted in varying amounts of systemic absorption. Various systemic toxicities have been attributed to these topical therapies, especially in patients with compromised renal function. The extent and area of the burn, degree of hydration, and the amount of drug applied are factors influencing transcutaneous absorption. Sulphonamide derivatives are excreted in the urine subsequent to the application of silver sulphadiazine cream, but silver ions appear to be localised on surface tissue and are thus unavailable to the subeschar space. Additional studies are needed to characterise the pharmacokinetics of medications commonly administered to burn patients. Unfortunately, the marked variability and fluctuations in pathophysiological status following burn trauma often confound the interpretation of such kinetic investigations.

Administration, Topical↗
PubMed2002

Topical treatment of pediatric patients with burns: a practical guide.

Over 440 000 children receive medical attention for burn injuries each year in the US. Burn wound infections are a major source of morbidity and mortality in these patients. Infected wounds not only heal more slowly, but also may lead to systemic infections. The factors that contribute to wound complications are both the size and depth of the wound. Burn depth is usually categorized into first-degree (superficial, involving only the epidermis), second-degree (partial thickness, involving both epidermis and dermis), and third-degree (full thickness, through the epidermis, dermis, and into fat). Burns that will not heal within 2 weeks are at least second-degree and should generally be referred to a burn surgeon for possible excision and grafting, due to the increased risk of infection and scarring. The burn wound is dynamic. Proper treatment minimizes the extent of the burn injury, whereas improper treatment (lack of proper wound-care, edema formation, lack of resuscitation) may actually increase the size and/or depth of the wound. Topical antimicrobial agents have been shown to decrease wound-related infections and morbidity in burn wounds when used appropriately. The goal of topical antimicrobial therapy is to control microbial colonization, thus preventing development of invasive infections. A wide variety of agents are available for treatment of burn wounds, including ointments, creams, biological and nonbiological dressings. Topical antimicrobials of choice include bacitracin, neomycin, silver sulfadiazine and mafenide.

Anti-Infective Agents, Local↗
PubMed1979

Pseudomonas resistance to gentamicin.

66 burned patients admitted to the Burn Unit from Jan. to Sept., 1977, were studied. Topical therapy employed was mafenide or silver sulfadiazine. The most common pathogens isolated in 288 burn wound cultures were Pseudomonas aeruginosa (42%), Klebsiella-Enterobacter (16%), and Staph, aureus (13%). Pseudomonas was sensitive to gentamicin in only 36.2% of instances. In 1976, 42% of Pseudomonas isolates was sensitive. During the period 1969-1973, 85.7% of the Pseudomonas was sensitive to gentamicin.

Burns↗
PubMed1999

[Clinico-laboratory effectiveness of modern ointments with a polyethylene glycol base in the treatment of purulent wounds].

The 25-year experience with the underbandage treatment of soft tissue purulent wounds of various location and genesis with modern ointments with polyethylene glycol as the basis was analyzed. Levocin, levomecole, dioxycole, 5-percent dioxydinic, 1-percent iodopyronic, 0.5-percent quinifuryl and furagel ointments proved to preserve their high activity against aerobic grampositive and gramnegative flora. 10-percent mafenide acetate ointment had a high selective effect on Pseudomonas aeruginosa. The new ointments nitacid and streptonitole containing nitazole and white streptocide were highly active against both aerobic and anaerobic infections. The use of the ointments with the polyethylene glycol as the basis made it possible to decrease 2 times the period of the patient hospitalization in surgical units and to shorten the terms of the systemic antibacterial therapy. The marked therapeutic effect of such ointments due to their high dehydrating capacity and broad antibacterial spectrum enabled to consider them as the drugs of choice in the local treatment of purulent wounds during the 1st phase of the wound process, trophic and decubic ulcers, infected burns, diabetic and atherosclerotic gangrene, furuncles, carbuncles, mastitis, etc. The ointments in the water soluble vehicle can be as well used with success for the prophylactic treatment of infected wounds after the suture. The multitarget effect of the ointments in the water soluble vehicle and their ability to prevent severe purulent complications permitted to consider them as the 1st order drugs in cases of emergency.

Anti-Bacterial Agents↗
PubMed1975

Topical treatment of the burn patient.

The pathophysiology, classification and bacteriology of burns are discussed, as well as treatment of burns with silver nitrate, silver sulfadizine, silver allantoinate, mafenide acetate, furazolium chloride, povidone-iodine complex, antibiotics, antiproteolytics, fibrinolytics, Pseudomonas vaccine and antiglobulins.

Administration, Topical↗
PubMed2005

The potential benefit of 5% Sulfamylon Solution in the treatment of Acinetobacter baumannii-contaminated traumatic war wounds.

BACKGROUND: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an investigation into their etiology. A review of the current guidelines for open combat casualty wounds as part of this broad investigation was not mentioned in the report. OBJECTIVE: The objective of this study was 2-fold: to ascertain the susceptibility of A. baumannii to currently available topical antibacterial agents and (2) to propose an alternative, effective treatment protocol for contaminated combat-related wounds so as to reduce or eliminate the likelihood of the wound serving as the source of A. baumannii infection or septicemia. METHODS: A standardized antimicrobial susceptibility study of 43 strains of A. baumannii collected from a tertiary care burn center was conducted using 2 commonly used topical antibacterial agents, 1% silver sulfadiazine cream (Silvadene) and 5% mafenide acetate solution (5% Sulfamylon Solution). RESULTS: Both were effective, but 5% Sulfamylon Solution demonstrated significantly greater antibacterial activity. CONCLUSION: Five percent Sulfamylon Solution, initially developed for wartime use, and currently limited by the Food and Drug Administration to soaks following meshed split-thickness autografts following excision of second-degree and third-degree burns, has a broad spectrum of antibacterial activity and extensive off-label applicability. It is an ideal agent for use in the treatment of war wounds, and should be considered as a superior replacement for normal saline in the current guidelines for open combat casualty wounds.

Journal Article↗
PubMed1991

[The open method of surgical treatment of suppurative wounds].

Treatment of purulent wounds by the open method in 280 patients was analysed. It is shown that purposeful use of medicinal agents in accordance with the phases of the wound process is a determinant and influences the duration of treatment. Necrectomy in combination with the topical use of ointments on a water-soluble polyethylene glycol basis (levosin, levomekol, 5% dioxidine ointment, 10% mafenide acetate ointment) produces the most favorable effect on the course of the wound process.

Combined Modality Therapy↗
PubMed1988

[Epicutaneous testing with a standard series. Results in 12,026 patients].

From 1977 to 1983, 12,026 patients were given patch tests with a standard series of substances. A total of 4,494 (37.4%) had positive patch-test reactions to one or more allergens; the average number of positive reactions was 1.85. The most frequent reactions were due to nickel sulphate (positive reactions in 9.2% of those tested), fragrance mix (8.9%), balsam of Peru (6.3%), cobalt chloride (4.7%), potassium dichromate (4.3%) and wool alcohols (4.3%). Women showed significantly more positive reactions than men to nickel sulphate, cobalt chloride, wool alcohols, and parabens and significantly fewer positive reactions than men to potassium dichromate, PPD mix, and epoxy resin. Younger patients showed significant more positive reactions to nickel sulphate and cobalt chloride; middle-aged patients reacted more to potassium dichromate, paraphenylendiamine, formaldehyde and thiuram mix; elderly patients reacted to balsam of Peru, wool alcohols, caine mix, neomycin sulfate, benzocaine, colophony, clioquinol, mafenide, parabens, and gentamycin sulfate.

Adult↗
PubMed1985

Topical cerium nitrate prevents postburn immunosuppression.

Suppression of cell-mediated immunity (CMI) follows a major thermal injury and is associated with an increased incidence of serious infections. Adult female CF-1 mice received a 20% full-thickness steam burn and were then treated with various topical antimicrobial creams in an attempt to alter the course of postburn immunosuppression. Topical agents included cerium nitrate (CE), silver sulfadiazine (SSD), mafenide (SML), silver nitrate (AG), and a mixture of CE and SSD (CE-SSD). CMI was determined in vivo by measuring ear swelling in response to 2,4-dinitrofluorobenzene (DNFB) challenge in previously sensitized mice. The usual nadir in CMI (ear swelling) when mice were sensitized at day 14 postburn did not occur in burned mice treated with CE or CE-SSD, AG was only modestly effective, and SML or SSD failed to restore CMI. These studies suggest that topical CE may have potential as an immunomodulator in the treatment of burns.

Animals↗
PubMed1971

British surgical aid to Jordan.

The surgical commitment of No. 2 Field Hospital, R.A.M.C., during its stay in Jordan is presented. The majority of patients that were admitted had sustained war wounds, many of which were infected due to the delay in treatment. The difficulties encountered in their subsequent management are discussed. Special reference is made to the use of ketamine (Ketalar) and mafenide acetate (Sulphamylon) in the treatment of those burns cases under our care. It is the first time for many years that a British field hospital has been employed in an active rôle.

Abdominal Injuries↗