Silver Sulfadiazine—A New Topical Therapy for Pseudomonas in Burns

AFTER thermal burns local and systemic infection, especially withPseudomonas aeruginosa, 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 byP aeruginosa, but both also produce characteristic fluid and electrolyte alterations. The hypotonic (29.4 millimol/liter) silver nitrate solution