A comparative study of the effect of different topical agents on burn wound infections

ABSTRACT

Background: Topical agents are used to treat burn wound infections. Aims and Objective: The present work was aimed to find out the in vitro efficacy of different topical agents against burn wound pathogens. Settings and Design: Randomly selected gram-positive (29) and gram-negative bacterial (119) isolates from burn wound cases admitted in burn unit of Choithram Hospital and Research Centre, Indore, were included in the in vitro activity testing for silver nitrate, silver sulphadiazine (SSD), chlorhexidine, cetrimide, nitrofuran, soframycin, betadine, benzalkonium chloride and honey by growth inhibition on agar medium. Materials and Methods: Multidrug-resistant isolates of gram-positive and gram-negative bacteria were checked for different topical agents. 1% topical agent was mixed with Mueller-Hinton agar. Two microlitres of bacterial suspension adjusted to 0.5 McFarland turbidity standard was spread over the topical agent containing plates. The plates without the topical agent were used as control plates. The plates were incubated for 48 h at 37΀C. Results: SSD (148/148), silver nitrate (148/148) and chlorhexidine (148/148) showed excellent activity against all the pathogens. Neosporin had poor activity against Pseudomonas aeruginosa, (4/44) Proteus spp. (2/4) and group D streptococci (1/4). Betadine did not show activity against the bacterial isolates in the presence of organic matter. Honey did not exert any antimicrobial activity under the study conditions. Conclusion: SSD, silver nitrate and chlorhexidine have excellent activity against all the bacterial pathogens and could be used empirically, while identification of the infective agent is required for selecting the alternative topical agents such as nitrofuran, soframycin, and benzalkonium chloride.

KEY WORDS

Benzalkonium chloride - burn wounds - cetrimide - chlorhexidine - nitrofuran - silver nitrate - silver sulphadiazine - topical gents

• 1 Dale RM, Schnell G, Wong JP. Therapeutic efficacy of Nubiotics against burn wound infection by Pseudomonas aeruginosa. Antimicrob Agents Chemother 2004;48:2918-23.
• 2 Monafo WW, West WA. Current treatment recommendations for topical burn therapy. Drugs 1990;40:364-73.
• 3 Vu H, McCony LF, Carino E, Washington J, Dang T, Villarreal C, et al. Burn wound infection susceptibilities to topical agents: The Nathan′s agar well diffusion technique. Pharmacy and Therapeutics 2002;27:390-96.
• 4 Moylan AJ. The proper use of local antimicrobial agents in wounds. World J Surg 1980;4:433-7.
• 5 Chopra I. The increasing use of silver based products as antimicrobial agents: A useful development or a cause for concern. J Antimicrob Chemother 2007;59:587-90.
• 6 Price WR, Wood M. Silver nitrate burn dressing. Treatment of seventy burned persons. Am J Surg 1966;112:674-80.
• 7 Moyer CA, Brentano L, Gravens DL, Margraf HW, Monafo WW. Treatment of large human burns with 0.5 percent silver nitrate solution. Arch Surg 1965;90:812-67.
• 8 Silver S. Bacterial silver resistance: Molecular biology and uses and misuses of silver compounds. FEMS Microbial Rev 2003;27:341-53.
• 9 Lansdown AB. Silver. 2. Toxicity in mammals and how its products aid wound repair. J Wound Care 2002;11:173-7.
• 10 Marshall JP, Schneider RP. Systemic argyria secondary to topical silver nitrate. Arch Dermato 1977;113:1077-9.
• 11 Lee AR, Moon HK. Effect of topically applied silver sulphadiazine on fibroblast cell proliferation and biochemical properties of wound. Arch Pharma Res 2003;26:855-60.
• 12 Fox CL Jr, Rappolg BW, Standford W. Conrol of Pseudomonas infection in burns by silver sulphadiazine. Sur gyneecol Obstet 1969;128:1021-6.
• 13 Heggers JP, Robson MC, Herndon DN, Desai MH. The efficacy of nystatin combined with topical microbial agents in the treatment of burn wound sepsis. J Burn Care Rehabil 1989;10:508-11.
• 14 Lindberg RB, Moncrief JA, Mason AD. Control of experimental and clinical wound sepsis by topical application of sulfamylon compounds. Ann N Y Acad Sci 1968;150:950-72.
• 15 Strock LL, Lee MM, Rutan RL, Desai MH, Robson MC, Herndon DN, et al. Topical Bactroban (mupirocin): Efficacy in treating burn wounds infected with methicillin-resistant staphylococci. J Burn Care Rehabil 1990;11:454-9.
• 16 Ross DA, Phipps AJ, Clarke JA. The use of cerium nitrate-silver sulphadiazine as a topical burn dressing. Br J Plast Surg 1993;46:582-4.
• 17 McRipley JR, Witney RR. Responsiveness of experimental surgical wound infections to topical chemotherapy. Antimicrob Agents Chemother 1976;10:45-51.
• 18 Modak SM, Fox CL. Sulphadiazine silver-resistant Pseudomonas in burns. New topical agents. Arch Surg 1981;116:854-7.
• 19 O′Meara SO, Cullum N, Majid M, Sheldon T. Systematic review of wound care management: (3) Antimicrobial agents. HealthTechnol Assess 2000;4:1-237.
• 20 O′Meara SO, Cullum N, Majid M, Sheldon T. Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 2001;88:4-21.
• 21 Wright JB, larn K, Burell RE. Wound management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment. Am J Infect Control 1998;26:522-77.
• 22 Wright JB, Hansen DL, Burrell RE. The comparative efficacy of two antimicrobial barrier dressing: In vitro examination of two controlled release silver dressing. Wounds 1998;10:179-88.
• 23 Furr JR, Russell AD, Turner TD, Andrew SA. Antibacterial activity of Actisorb plus, Actisorb and silver nitrate. J Hosp Infect 1994;27:201-8.
• 24 Bowler PG, Jones SA, Walker M, Parsons D. Microbicidal properties of a silver containing hydrofibre dressing against a varity of burn wound pathogens. J Burn Care Rehab 2004;25:192-6.
• 25 Jones SA, Bowler PG, Walker M, Parsons D. Controlling wound bioburden with novel silver containing hydro fibre dressing. wound repair and regeneration 2004;12:288-94.
• 26 Viala J, Simon L, Le Pommelet C, Philippon L, Devictor D, Huault G. Agranulocytosos after application of silver sulfadiazine in a 2-month old infant. Arch Pediatr 1997;4:1103-6