Topical antibiotics in burn

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 340

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شناسه ملی سند علمی:

NCBMED08_001

تاریخ نمایه سازی: 18 تیر 1398

چکیده مقاله:

The prevention of infection in the burn patient is extremely difficult because burn wound sites are favorable for bacterial overgrowth, the epidermal barrier is often defective for extended periods, and the patients are in the hospital, where multiple antibiotic-resistant organisms are found. The ultimate goal of burn-wound management is closure and healing of the wound. Early surgical excision of burned tissue, with extensive debridement of necrotic tissue and grafting of skin or skin substitutes, greatly decreases mortality rates associated with severe burns.In addition, the some widely used topical antimicrobial agents—silver sulfadiazine cream, mafenide acetate cream, silver nitrate cream, and nanocrystalline silver dressings, dramatically decrease the bacterial burden of burn wounds and reduce the incidence of burn-wound infection; these agents are routinely applied to partial- and full-thickness burns.Characteristics of an ideal topical agent: a broad antimicrobial spectrum, Painless, No systemic absorption, No wound healing retardation, Inexpensive, Easy to apply, Good eschar penetration, Not toxic to fibroblasts, Long lasting, Easy to store, rapid bactericidal activity, persistent activity on the skin and wound, an absence of irritating, allergic, or toxic reactions, absence of systemic absorption, activity in the presence of body fluids and secretion (e.g. blood), cosmetic acceptance.There is evidence that effective topical antibacterial therapy delays colonization of the burn wound for a variable period (measured in days, not weeks), maintains the bacterial density of the wound at lower levels than those which could otherwise be achieved and for appreciable intervals (measured in weeks), and tends to result in a relatively homogeneous and less diverse wound flora than that which would otherwise be expected.Silver sulfadiazine: The bactericidal properties of silver are related to its effect on respiratory enzymes on bacterial cell walls; its interaction with structural proteins causes keratinocyte and fibroblast toxicity that can delay wound healing if silver-based compounds are used indiscriminately. Silver sulfadiazine is often used initially, but its value can be limited by bacterial resistance, poor wound penetration, or toxicity (leukopenia).Mafenide acetate has broader activity against gram-negative bacteria. The cream penetrates eschars and thus can prevent or treat infection beneath them; its use without dressings allows regular examination of the wound area. The foremost disadvantages of mafenide acetate are that it can inhibit carbonic anhydrase, resulting in metabolic acidosis, and that it elicits hypersensitivity reactions in up to 7% of patients. This agent is most often used when gram-negative bacteria invade the burn wound and when treatment with silver sulfadiazine fails. The activity of mafenide acetate against gram-positive bacteria is limited.The other topical agents that are used in burn wounds are Nitrofurazone, Mupirocin, Gentamicin sulfate, Bacitracin, Polymyxin B, and Sodium hypochlorite.

نویسندگان

Maryam Roham

Infectious diseases specialist