Silver Sulfadiazine—A New Topical Therapy for Pseudomonas in Burns

TLDR

Thermal burns frequently lead to local and systemic infections, especially with *Pseudomonas aeruginosa*, and historical studies have explored topical antibacterial agents such as sodium sulfadiazine, though they also cause fluid and electrolyte disturbances. The authors applied a 29.4 mM hypotonic silver nitrate solution as the topical therapeutic agent. Earlier trials demonstrated promising outcomes, and the present study confirms that dilute silver nitrate solutions effectively treat *Pseudomonas* burn wound sepsis, reviving interest in local antibacterial therapy.

Abstract

AFTER thermal burns local and systemic infection, especially with<i>Pseudomonas aeruginosa</i>, is a major cause of death. The use of soluble sodium sulfonamides in wounds and burns was investigated during World War II,¹and in studies of extensive burns,²topical antibacterial therapy was combined with treatment for the burn wound by using a neutralized mixture of tannic acid and sodium sulfadiazine. Although the results were good, emphasis shifted to the role of sodium salts in systemic therapy in an era of disbelief in the efficacy of local antibacterial therapy. As predicted in 1952 by Meleney,³there is now a renaissance of topical antibacterial therapy with the introduction of dilute silver nitrate solutions⁴and mafenide-containing ointments. ⁵Both agents are effective in burn wound sepsis, especially that caused by<i>P aeruginosa</i>, but both also produce characteristic fluid and electrolyte alterations. The hypotonic (29.4 millimol/liter) silver nitrate solution