Burns. 6, 135-l 37 Printedin Great Britain 135

Abstracts

CLINICAL STUDIES Sulphamylon versus silver sulphadiazine From a series of 645 patients with extensive bums, 175 were treated without application of either topical anti- bacterial agent, 156 received sulphamylon and 314 received silver sulphadiazine. Statistical comparisons of the groups showed that compared with the control patients, silver sulphadiazine proved superior in relation to clinical infection rate and culture rate in reduction of pseudomonas and staphylococci. There were significant reductions in both groups for Escherichia coli and Candida albicans. Althouah pneumonia was found in both groups of patients receiving these topical antibacterial agents the overall mortality was markedly reduced when silver sulpha- diazine was used.

Pegg S. P., Ramsay K., Meldrum L. et al. (1979) Clinical comparison of maphenide and silver sulpha- diazine. Stand. J. Plast. Reconstr. Surg. 13,95.

A pseudomonas vaccine A vaccine prepared by heat-killing 10 different strains of pathogenic Pseudomonas aeruginosa has been used in 287 patients with bums covering more than 25 per cent of the body surface. The effectiveness of the vaccine was assessed by the rate of development of high titres of antibodies to P. aeruginosa the incidence of positive blood cultures with this organism and the number of fatal septicaemias in patients treated with or without the vaccine. The vaccinated patients showed high titres of antibodies after day 10 post bum, only 9 blood cultures positive for P. aeruginosa (com- pared wtih 37 in the unvaccinated patients) and a much lower mortality following vaccination.

Wassermann D., Schlotterer M., Paul P. et al. (1979) Systematic utilization of an antipseudomonas aeru- ginosa vaccine in a severe burn unit. Stand. J. Plust. Reconstr. Surg. 13,8 1.

Gentamicin-resistant pseudomonas Between January and September 1977, 66 patients with extensive bums were treated with either mafenide or silver sulphadiazine applied topically to the burned area. The most commonly isolated bacteria from 288 bum wound cultures were Pseudomonas aeruginosa (42 per cent), klebsiella+nterobacter (16 per cent) and Staphylococcus aureus (13 per cent).

Only 36.2 per cent of the isolated strains of P. aeruginosa were sensitive to gentamicin during 1977, whereas during 1976,42 per cent of the isolated strains of I? aeruginosa were sensitive, and during the period between 1969 and 1973, 85.7 per cent of the isolated strains ofpseudomonas were sensitive to gentamicin.

Ramirez A. T., Melendres F. A. and Capili C. A. (1979) Pseudomonas resistance to gentamicin. Sand. J. Plast. Reconstr. Surg. 13,69.

Excision or exposure? After calculation of the mortality rates of 2460 patients treated by the exposure method between 1962 and 197 1 and of a smaller group of patients treated between 1972 and 1975 bv earlv excision (within the first 24 h of burning) and grafting, a prospective randomized trial of these forms of treatment was started in 1976. Preliminary results indicate remark- ably similar mortality rates in the two groups of patients in the controlled trial; which is continuing.

Sorensen B. (1979) Acute excision or exposure treatment? Stand. J. Plast. Reconstr. Surg. 13, I 15.

ANIMALSTUDIES Metal sulphonamides The apparent effmacy of zinc and cerium sulphadia- zine in the treatment of animals and patients with grossly contaminated bum wounds, and the metabolic role of other trace metals suggested that the sulphon- amide salts of these might also be of therapeutic value. Accordingly other sulphonamide salts of zinc were prepared and studied in vitro and in vivo. Only zinc sulphathiazole and zinc methoxazole were as effective as zinc sulphadiazine in studies with infected burned animals. The sulphadiazines of aluminium. chromium, cobalt, copper and iron were prepared and compared in vitro and in vivo. Only cobalt sulpha- diazine appeared comparable to zinc and cerium sulphadiazine in healing bum wounds in rats. Studies on the molecular structure of silver sulphonamides disclosed the polymeric structure peculiar to silver sulphadiazine which appears to account for its unique properties. It is not yet known whether other metal sulphadiazines have this attribute.

Fox C. L., Modak S., Stanford J. W. et al. (1979) Metal sulfonamides as antibacterial agents in topical therapy. Stand. J. Plast. Reconstr. Surg. 13,89.