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Current Pharmaceutical Design 2023The insertion of topical antimicrobials in wound treatment represented an important role in patient management. Among these agents, silver sulfadiazine (AgSD),... (Review)
Review
The insertion of topical antimicrobials in wound treatment represented an important role in patient management. Among these agents, silver sulfadiazine (AgSD), introduced in the therapy of wounds and burns in the 1960s, is considered the gold standard in treatment due to its mechanism of action, in addition to its proven efficacy and safety. The association of AgSD with polymers for the development of curative formulations has been reported. The evaluation of the physical-chemical properties of these systems with the aid of analytical techniques of characterization is essential for the determination of their activities, besides allowing the detection of possible incompatibilities between AgSD and polymers. Thus, this review presents the main techniques of physicochemical characterization used in the evaluation of systems containing AgSD with curative purposes in order to provide parameters to ensure the efficacy and safety of these new therapeutic options. Microscopic, thermoanalytical, and spectroscopic techniques, for example, provide information on system properties such as surface chemical composition, crystallinity, morphology, and thermal stability of curative formulations containing AgSD. These techniques are important in the selection of the most appropriate techniques during the development of a polymeric curative system containing AgSD, in addition to providing information for cost reduction of a possible scale-up and the establishment of methodologies for quality control of these systems to ensure their efficacy and safety.
Topics: Humans; Silver Sulfadiazine; Anti-Infective Agents, Local; Bandages; Polymers
PubMed: 36967465
DOI: 10.2174/1381612829666230324122925 -
Journal of Biomaterials Applications Apr 2021(Bio)nanocomposites have been studied for biomedical applications, including the treatment of wounds. However, wound infection is one of the main problems of wound care...
(Bio)nanocomposites have been studied for biomedical applications, including the treatment of wounds. However, wound infection is one of the main problems of wound care management, and the use of wound dressings with antibacterial agents is essential. This work focused on developing and characterizing silver sulfadiazine-loaded halloysite/cassava starch-based (bio)nanocomposites potentially suitable as antimicrobial dressing. Silver sulfadiazine was complexed inside the halloysite nanotubes lumen, and the drug-loaded nanotubes were incorporated in thermoplastic starch dispersion, forming the (bio)nanocomposites. The silver sulfadiazine-loaded halloysite and the (bio)nanocomposite were characterized by zeta potential, scanning electron microscopy, X-ray diffraction, and infrared spectroscopy. The dressing properties of (bio)nanocomposites (water vapor permeability and mechanical stability) and their antimicrobial efficacy by , and were also evaluated. Physicochemical studies suggested the silver sulfadiazine-loaded halloysite complexation (zeta potential of -38.9 mV) and its interactions with the starch forming the nanocomposites. The silver sulfadiazine-loaded halloysite/starch-based (bio)nanocomposites possessed a homogeneous and organized structure. Also, they had mechanical properties to be used as a dressing (13.73 ± 3.09 MPa and 3.17 ± 1.28% of elongation at break), and its permeability (6.18 ± 0.43 (10) g.Pa.s.m) could be able to maintain the environmental moisture at the wound surface. Besides that, the (bio)nanocomposites acted against the studied bacteria, being a potential contact antimicrobial and biodegradable wound dressing. Finally, the developed (bio)nanocomposites are semi-occlusive and good candidates for dry wounds to be widely and tested as controlled silver sulfadiazine delivery dressing.
Topics: Anti-Bacterial Agents; Bandages; Biocompatible Materials; Clay; Escherichia coli; Manihot; Nanocomposites; Permeability; Pseudomonas aeruginosa; Silver Sulfadiazine; Spectroscopy, Fourier Transform Infrared; Staphylococcus aureus; Starch; Steam; X-Ray Diffraction
PubMed: 33611961
DOI: 10.1177/0885328221995920 -
Scandinavian Journal of Plastic and... 1984Topical antibacterial treatment is of major importance in the burn patient. Silver sulfadiazine is an effective agent with low toxicity and few side effects. Deposition... (Review)
Review
Topical antibacterial treatment is of major importance in the burn patient. Silver sulfadiazine is an effective agent with low toxicity and few side effects. Deposition of silver in tissues, and absorption of sulfadiazine are both minimal. Present and future problems are represented by the emergence of resistant Gram negative bacilli, including Pseudomonas aeruginosa. The development of related metal sulfadiazines to be used against resistant bacteria is on an investigational stage, and clinical trials are few. Silver sulfadiazine may be used in a variety of other conditions than burns.
Topics: Administration, Topical; Animals; Bacterial Infections; Burns; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Silver Sulfadiazine; Sulfadiazine; Wounds and Injuries
PubMed: 6377481
DOI: 10.3109/02844318409057413 -
Journal of Burn Care & Research :... 2009Silver sulfadiazine cream has an enviable safety record in burn treatment. However, it side effects, exemplified by allergic reactions to its sulfadiazine moiety, silver... (Review)
Review
Silver sulfadiazine cream has an enviable safety record in burn treatment. However, it side effects, exemplified by allergic reactions to its sulfadiazine moiety, silver staining of the treated burn wound, hyperosmolality, methemoglobinemia, and hemolysis due to a congential lack of glucose-6-phospate dehydrogenase, may be missed or misinterpreted. Early post burn leukopenia, once thought to be a side effect of the use of silver sulfadiazine in burn wound therapy, is no longer regarded as such since it has been found to occur with the use of other burn topical agents. Its presence is no longer an indication to discontinue silver sulfadiazine burn wound therapy. Because these side effects are uncommon, any one physician or burn facility usually has limited experience in diagnosing and treating them.
Topics: Burns; Drug Resistance, Bacterial; Humans; Hypersensitivity; Ointments; Risk Factors; Silver Sulfadiazine; Skin Absorption
PubMed: 19349889
DOI: 10.1097/BCR.0b013e3181a28c9b -
Burns : Journal of the International... Feb 2017Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with... (Comparative Study)
Comparative Study Review
Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD -5.76days, 95% CI -8.14 to -3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58-2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns.
Topics: Anti-Infective Agents, Local; Bandages; Burns; Honey; Humans; Randomized Controlled Trials as Topic; Silver Sulfadiazine; Wound Healing; Wound Infection
PubMed: 27576926
DOI: 10.1016/j.burns.2016.07.004 -
Drug Metabolism and Personalized Therapy Aug 2020Objectives Patients with serious injury need special care and treatment to control the infection, as wound sepsis is one of the major causes of death. Silver...
Objectives Patients with serious injury need special care and treatment to control the infection, as wound sepsis is one of the major causes of death. Silver sulfadiazine (SSD) is widely used as an antimicrobial agent which promotes healing and re-epithelialization. However, due to certain drawbacks such as inflammation and cytotoxicity, the need for novel drug delivery modality emerges. The objective of this study was to develop natural polymeric (chitosan and gelatin) hydrogel sponges containing SSD and evaluate its efficacy in wound healing using animal models. Methods SSD containing hydrogel sponges were prepared by solvent casting technique. Scanning electron microscopy (SEM) and Differential scanning calorimetry (DSC) were used to evaluate morphological characteristics of the hydrogel sponges. Anti-thrombogenic property, drug release studies, drug release kinetics, antimicrobial property, and wound healing effect were also studied in detail. Results The optimized batch of hydrogel sponges (CG4) consists of 1% SSD wt., 10% wt. Gelatin, 1% wt. Chitosan and honey 7.5% wt. as plasticizer. At the 12th hour, in vitro and ex vivo drug release was found to be 76.994±0.67% and 24.22±0.57% respectively. CG4 batch had enhanced in vitro antimicrobial activity as compared to conventional marketed cream. The developed SSD hydrogel sponges showed a faster rate of wound healing as compared to a marketed cream. Animals treated with CG4 formulation showed complete angiogenesis and re-epithelialization by 8th day, whereas 12 days were required for complete wound healing with marketed cream. Conclusions The prepared hydrogel sponges can serve as a potential alternative for wound healing dressing as compared to the marketed product.
Topics: Animals; Anti-Bacterial Agents; Bacteria; Bandages; Chitosan; Disease Models, Animal; Fungi; Gelatin; Humans; Hydrogels; Rats; Rats, Wistar; Silver Sulfadiazine; Wound Healing
PubMed: 32827392
DOI: 10.1515/dmpt-2020-0124 -
The Western Journal of Medicine Sep 2001
Comparative Study Review
Topics: Bandages, Hydrocolloid; Burns; Coated Materials, Biocompatible; Colloids; Drug Evaluation; Honey; Humans; Occlusive Dressings; Silver Sulfadiazine; Wound Healing
PubMed: 11527855
DOI: 10.1136/ewjm.175.3.205 -
Journal of Burn Care & Research :... Sep 2021A variety of dressings is available for the treatment of partial-thickness wounds, but none has strong evidence supporting their beneficial effect on healing. This may...
A variety of dressings is available for the treatment of partial-thickness wounds, but none has strong evidence supporting their beneficial effect on healing. This may be due to variation in the type and depth of wounds in clinical studies. The aim of this study was to use a standardized porcine wound model to compare three dressings commonly used in burn centers for partial-thickness burns. Partial-thickness scalds were made on the flanks of pigs. Wounds were treated with silver sulfadiazine (SSD, flammazine), a hydrofiber dressing, or glycerol-preserved allogeneic (pig) skin. The healing process was monitored for 8 weeks. Macroscopic parameters were the itching behavior, the cosmetic appearance of the scars, and contraction. Microscopic parameters were the inflammatory response, myofibroblast influx, and the numbers of nerves. All wounds were closed on day 14 and wound infection did not occur. Treatment with SSD resulted in significantly more wound contraction compared to treatment with glycerol-preserved pig skin. Animals treated with SSD suffered more from itching (scratching) during the first 2 weeks after wounding. The number of nerves in healing wounds of these animals was significantly higher compared to wounds treated with hydrofiber dressing or allogeneic skin. In our standardized porcine partial-thickness wound model, treatment with SSD resulted in less favorable wound healing. Compared to treatment with glycerol-preserved allogeneic skin, SSD resulted in more contraction.
Topics: Animals; Anti-Infective Agents, Local; Bandages; Burns; Pruritus; Silver Sulfadiazine; Swine; Wound Healing; Wound Infection
PubMed: 33528565
DOI: 10.1093/jbcr/irab028 -
The Cochrane Database of Systematic... Mar 2013An acute burn wound is a complex and evolving injury. Extensive burns produce systemic consequences, in addition to local tissue damage. Treatment of partial thickness... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
An acute burn wound is a complex and evolving injury. Extensive burns produce systemic consequences, in addition to local tissue damage. Treatment of partial thickness burn wounds is directed towards promoting healing and a wide variety of dressings are currently available. Improvements in technology and advances in understanding of wound healing have driven the development of new dressings. Dressing selection should be based on their effects on healing, but ease of application and removal, dressing change requirements, cost and patient comfort should also be considered.
OBJECTIVES
To assess the effects of burn wound dressings on superficial and partial thickness burns.
SEARCH METHODS
For this first update we searched The Cochrane Wounds Group Specialised Register (searched 8 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (2008 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 07, 2012); Ovid EMBASE (2008 to 2012 Week 44); AND EBSCO CINAHL (1982 to 2 November 2012).
SELECTION CRITERIA
All randomised controlled trials (RCTs) that evaluated the effects of burn wound dressings on the healing of superficial and partial thickness burns.
DATA COLLECTION AND ANALYSIS
Two authors extracted the data independently using standardised forms. We assessed each trial for internal validity and resolved differences by discussion.
MAIN RESULTS
A total of 30 RCTs are included in this review. Overall both the quality of trial reporting and trial conduct were generally poor and meta analysis was largely precluded due to study heterogeneity or poor data reporting. In the context of this poor quality evidence, silver sulphadiazine (SSD) was consistently associated with poorer healing outcomes than biosynthetic (skin substitute) dressings, silver-containing dressings and silicon-coated dressings. Burns treated with hydrogel dressings appear to heal more quickly than those treated with usual care.
AUTHORS' CONCLUSIONS
There is a paucity of high-quality evidence regarding the effect of different dressings on the healing of superficial and partial thickness burn injuries. The studies summarised in this review evaluated a variety of interventions, comparators and clinical endpoints and all were at risk of bias. It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care.
Topics: Bandages; Bandages, Hydrocolloid; Burns; Humans; Randomized Controlled Trials as Topic; Silicon Compounds; Silver Sulfadiazine; Skin, Artificial; Wound Healing
PubMed: 23543513
DOI: 10.1002/14651858.CD002106.pub4 -
Burns : Journal of the International... May 2022Nanocrystalline silver dressings can reduce the number of changes, facilitating burn wound management. However, the evidence regarding their efficacy and... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy and costs of nanocrystalline silver dressings versus 1% silver sulfadiazine dressings to treat burns in adults in the outpatient setting: A randomized clinical trial.
BACKGROUND
Nanocrystalline silver dressings can reduce the number of changes, facilitating burn wound management. However, the evidence regarding their efficacy and cost-consequences compared to well-established treatments, such as 1% silver sulfadiazine, is still scarce.
OBJECTIVE
To determine the efficacy, safety, and costs of nanocrystalline silver dressings compared to 1% silver sulfadiazine dressings to treat adult patients with burns.
STUDY DESIGN AND SETTING
Randomized, single-center, single-blind trial conducted at a referral hospital in São Paulo, Brazil.
METHODS
100 adult patients were randomized 1:1 to nanocrystalline silver (n = 50) or 1% silver sulfadiazine (n = 50). The primary outcome was the proportion of participants with complete re-epithelization at day 15 after randomization. Secondary outcomes included the number of dressing changes, direct medical costs (in international dollars, I$), pain intensity, the incidence of infections, number of patients undergoing surgery, and adverse events.
RESULTS
On day 15, the proportion of patients who reached the primary outcome did not differ significantly between participants treated with nanocrystalline silver dressings (24 [48%]) and those treated with 1% silver sulfadiazine dressings (26 [52%]); risk difference of -4.0 percentage points (95% confidence interval [CI], -17 to 9; P = 0.56). The number of patients undergoing surgical intervention was similar between groups (6% vs. 6%), and no local or serious adverse events were reported. The mean (standard deviation, SD) number of dressing changes in the nanocrystalline silver group was 4.1 (2.3), and the corresponding estimate in the 1% silver sulfadiazine group was 9.6 (6.7); mean difference of -5.56 (95% CI), -7.57 to -3.55, P < 0.001). Treatment with nanocrystalline silver dressing incurred significant cost reductions in medical materials, human resources, and administrative labor. However, the mean total cost with nanocrystalline silver dressing was higher compared to 1% silver sulfadiazine dressings: I$496.37 (445.90) vs. I$274.73 (182.76); mean difference = 221.63 (95% CI, 89.04 to 354.23, P = 0.001). The main driver of higher mean total costs among nanocrystalline silver-treated participants was the purchase cost of the dressings, representing 79.3% of the total cost in the nanocrystalline silver group but only 15.2% in the 1% silver sulfadiazine group.
CONCLUSION
We found no evidence of a difference between nanocrystalline silver and 1% silver sulfadiazine dressings regarding efficacy and safety outcomes. Nanocrystalline silver dressings were associated with an increase in the total costs, but they could result in important savings for an institution (less changes of dressings, reducing human resources burden), especially if acquisition costs can be decreased. Additional cost-effectiveness studies are warranted.
TRIAL REGISTRATION NUMBER
NCT02108535.
Topics: Adult; Anti-Infective Agents, Local; Bandages; Brazil; Burns; Humans; Outpatients; Silver; Silver Sulfadiazine; Single-Blind Method
PubMed: 34688520
DOI: 10.1016/j.burns.2021.05.014