Mafenide

Abstract: This study evaluated the antimicrobial activity of ACTICOAT Antimicrobial Barrier Dressing (Westaim Biomedical Corp, Fort Saskatchewan, Alberta, Canada), a silver-coated wound dressing, and compared it with silver nitrate, silver sulfadiazine, and mafenide acetate. The minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC), zone of inhibition, and killing curves were determined with 5 clinically relevant bacteria. The data indicate that ACTICOAT silver had the lowest MIC and MBC and generated similar zones of inhibition to silver nitrate and silver sulfadiazine. Viable bacteria were undetectable 30 minutes after inoculation with the dressing, whereas it took 2 to 4 hours for silver nitrate and silver sulfadazine to achieve the same result. Mafenide acetate generated the biggest zones of inhibition, but it had the highest MICs and MBCs, and a significant number of bacteria still survived after 6 hours of treatment. The results suggest that ACTICOAT Antimicrobial Barrier Dressing has better antimicrobial performance than either of the existing silver-based products. ACTICOAT dressing killed the bacteria that were tested much faster, which is a very important characteristic for a wound dressing acting as a barrier to invasive infection to have. The study also suggests that a single susceptibility test such as a MIC or zone of inhibition test does not provide a comprehensive profile of antimicrobial activity of a topical antimicrobial agent or dressing. A combination of tests is desirable.

Abstract: Infections in burn patients continue to be the primary source of morbidity and mortality. Topical antimicrobial therapy remains the single most important component of wound care in hospitalised burn patients. The goal of prophylactic topical antimicrobial therapy is to control microbial colonisation and prevent burn wound infection. In selected clinical circumstances topical agents may be used to treat incipient or early burn wound infections. At the present time silver sulfadiazine is the most frequently used topical prophylactic agent; it is relatively inexpensive, easy to apply, well tolerated by patients, and has good activity against most burn pathogens. In patients with large burns the addition of cerium nitrate to silver sulfadiazine may improve bacterial control. Mafenide acetate has superior eschar-penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis. However, the duration and area of mafenide application must be limited because of systemic toxicity associated with prolonged or extensive use. Other agents, such as nitrofurazone or chlorhexidine preparations, may be useful in isolated clinical situations. The undesirable side effects of silver nitrate solution limit its use by most clinicians at the present time.

Abstract: 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.