title: An in vitro study of the anti-microbial efficacy of a 1% silver sulphadiazine and 0.2% chlorhexidine digluconate cream, 1% silver sulphadiazine cream and a silver coated dressing.
abstract: Burn sepsis is a leading cause of mortality and morbidity in patients with major burns. The use of topical anti-microbial agents has helped improve the survival in these patients. There are a number of anti-microbials available, one of which, Silvazine (1% silver sulphadiazine (SSD) and 0.2% chlorhexidine digluconate), is used only in Australasia. No study, in vitro or clinical, had compared Silvazine with the new dressing Acticoat. This study compared the anti-microbial activity of Silvazine, Acticoat and 1% silver sulphadiazine (Flamazine) against eight common burn wound pathogens.
  
  
  METHODS
  Each organism was prepared as a suspension. A 10 microl inoculum of the chosen bacterial isolate (representing approximately between 10(4) and 10(5) total bacteria) was added to each of four vials, followed by samples of each dressing and a control. The broths were then incubated and 10 microl loops removed at specified intervals and transferred onto Horse Blood Agar. These plates were then incubated for 18 hours and a colony count was performed.
  
  
  RESULTS
  The data demonstrates that the combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) results in the most effective killing of all bacteria. SSD and Acticoat had similar efficacies against a number of isolates, but Acticoat seemed only bacteriostatic against E. faecalis and methicillin-resistant Staphylococcus aureus. Viable quantities of Enterobacter cloacae and Proteus mirabilis remained at 24h.
  
  
  CONCLUSIONS
  The combination of 1% SSD and 0.2% chlorhexidine digluconate (Silvazine) is a more effective anti-microbial against a number of burn wound pathogens in this in vitro study. A clinical study of its in vivo anti-microbial efficacy is required.
authors.affiliation: Department of Paediatrics and Child Health, Royal Children's Hospital, Queensland Health Pathology Service, University of Queensland, Herston 4029, Qld, Brisbane, Australia. j.fraser@uq.edu.au
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
authors.forename: Jan
authors.initials: J
authors.lastname: Bodman
authors.forename: Ruth
authors.initials: R
authors.lastname: Sturgess
authors.forename: Joan
authors.initials: J
authors.lastname: Faoagali
authors.forename: Roy M
authors.initials: RM
authors.lastname: Kimble
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development; D001458:Bandages; D002056:Burns / Q000382:microbiology; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000494:pharmacology*; D015169:Colony Count, Microbial; D004338:Drug Combinations; D006801:Humans; D066298:In Vitro Techniques; D008826:Microbial Sensitivity Tests / Q000379:methods; D009824:Ointments; D012834:Silver / Q000494:pharmacology*; D012837:Silver Sulfadiazine / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D009824:Ointments; D012834:Silver; C010882:chlorhexidine gluconate; D002710:Chlorhexidine; D012837:Silver Sulfadiazine