Topical chemoprophylaxis with silver sulphadiazine and silver nitrate chlorhexidine creams: emergence of sulphonamide-resistant Gram-negative bacilli.

Abstract

BRITISH MEDICAL JOURNAL 28 FEBRUARY 1976 493 allergens in maltworkers with extrinsic allergic alveolitis than in the rest of the maltworker population, and (c) atopic maltworkers had a significantly lower rate of skin sensitivity to occupational allergens than non-atopic workers. The first observation is not surprising, since extrinsic allergic alveolitis is not due to a type 1 allergic reaction. The second is of interest, since it suggests that the type 3 allergic reaction responsible for the disease may be accompanied by a type 1 reaction to the same allergen. The third is difficult to explain except, perhaps, on the rather dubious hypothesis that skin sensitivity to common allergens in some way inhabits the development of skin sensitivity to occupational allergens. It would appear, however, that this phenomenon does not protect such patients from the type 3 antigen-antibody reaction believed to be responsible for extrinsic allergic alveolitis. With increasing mechanisation of the malting process the prevalence of this disease is likely to diminish rapidly, and there may never be another opportunity to confirm or refute the hypothesis that in most cases extrinsic allergic alveolitis is a pulmonary allergic reaction to inhaled spores of A clavatus.

Drug resistance in relation to use of silver sulphadiazine cream in a burns unit.

“…These drugs were withdrawn because of the emergence of a very high incidence of sulphonamideresistant Enterobacteria during the trial of silver sulphadiazine on extensive burns (Lowbury et al, 1976). …”

“…Silver sulphadiazine cream has been widely used, and though resistance to sulphonamides seemed likely to emerge if this agent was used for routine prophylaxis, this was not reported in various trials of silver sulphadiazine cream Stanford et al, 1969;Hummel et al, 1970), including our own trials on smaller burns (Lowbury et al, 1971a and b). However, a recent trial of silver sulphadiazine cream in extensively Received for publication 15 June 1976 160 burned patients, which showed it to havesomeprophylactic advantages over 0 5 % silver nitrate compresses, also showed that a large proportion of the Enterobacteriaceae in burns became highly resistant to sulphadiazine during the trial; this was associated with a reduced prophylactic effectiveness of silver sulphadiazine cream (Lowbury et al, 1976).…”

“…Resistance of Enterobacteriaceae from burns to sulphonamides and other antimicrobial agents MATERIAL AND METHODS Gram-negative bacilli were isolated from burns as described elsewhere (Lowbury et al, 1976). One strain of every coldny type isolated per patient per burns between 1965 and 1975 which were resistant to sulphadiazine.…”

Development of an artificial dermis preparation capable of silver sulfadiazine release

“…Ag‐SD, a topical antibacterial agent, has been widely used for the treatment of burn wound infections 9–15. Ag‐SD is an organic complex of ionizable silver and sulfadiazine, and the silver ion acts as a bacteriostatic and bactericidal agent 16–26…”

Synergism between Chlorhexidine and Sulphadiazine

“…It causes leakage of 260 nm absorbing material from a wide variety of bacteria (Hugo & Longworth 1964) and affects the structure of proteins, inhibiting, for example, membrane-bound ATPase (Harold et al 1969), altering the configuration of proteins and facilitating the uptake of polymyxin by cells (Al-Najjar & Quesnel 1978). The combination of silver nitrate and chlorhexidine has prophylactic properties in burn therapy comparable with those of silver sulphadiazine and resistance does not emerge to either of the former (Lowbury et al 1976).…”