⑴Sulfamilon: In the 1960s, Moncrief first made 10 sulfamilon cream as a topical medicine for burn wounds. Clinically applied 10% aqueous solution or cold cream can penetrate the eschar within 30 minutes. Within 5 hours, 80-90% of the drug area leaves the carrier. After 8-10 hours, the drug loses its antibacterial effect. Excreted by the kidneys. The main features are obvious wound pain after application. Metabolic acidosis will occur due to inhibition of carbonobacterium enzymes when applied to large areas, so pay attention to pulmonary complications; hypertonicity often leads to polyuria or destruction of new epidermal cells. Application method: Apply 10 sulfamilon cold cream directly on the wound surface, about 1 to 2 mm, twice a day. The second application should first remove the last drug, and the daily dosage should not exceed 450g. Severe Pseudomonas aeruginosa In case of infection, a 5-10% aqueous solution can be used in a water bath.
⑵ Silver sulfadiazine (DS-Ag) and N-sulfadiazine compounds. SD-Ag is a weak acid and a broad-spectrum inhibitor. It is effective against Pseudomonas aeruginosa and other common bacteria on wounds. It is generally effective, but less effective against Clomycin and Whitebacterium. Silver sulfadiazine penetrates the eschar and releases silver ions and sulfadiazine, forming a thin layer of light gray scab on the wound surface. Most of the released silver ions bind to bacterial DNA and inhibit bacterial growth. Silver ions are rarely absorbed by the body. About 10% of sulfadiazine is absorbed, and the concentration in the blood can reach 1.5 to 4 mg within 3 to 4 days of application.
Silver sulfadiazine has a significant effect on delaying and reducing wound infection, and is more effective in controlling wound infection. good. Although various topical drugs have emerged, silver sulfadiazine is still one of the most effective topical drugs. Silver sulfadiazine can cause sulfonamide crystalluria, rash, flake dermatitis, and leukopenia.
Among the N-metal sulfonamide drugs, there are silver salts, zinc salts and cerium salts such as sulfadiazine, sulfamethylpyrimidine and sulfadimethylpyrimidine. Zinc salts can promote wound healing, while cerium salts have lower water-soluble goodmycins, but their minimum inhibitory concentrations are higher than those of silver salts, indicating that silver salts are still antibacterial drugs. To combine the advantages of zinc salt and silver salt. People also studied how to make silver zinc cream. Since silver sulfadiazine faces drug problems, people have developed silver salts of silver niacin, silver aspartate and quinolones (representative drugs are nalidinol, piperonic acid, and norfloxacin), especially piperonic acid. The antibacterial concentrations of silver and silver norfloxacin are lower than that of silver sulfadiazine, and they have broad application prospects.
⑶ Chlorhexidine (chlorhexidine) and its mixtures: Chlorhexidine is effective against Gram-positive cocci and negative bacilli, with good clinical efficacy and no obvious irritation. In the clinical treatment of burns, 1‰ chlorhexidine solution is commonly used to clean the wound surface or be used as an inner dressing.
In order to improve the efficacy, chlorhexidine and other topical drugs are often mixed. Chlorhexidine plus silver nitrate; neomycin plus polymyxin B plus chlorhexidine; sulfamisan plus silver sulfadiazine plus chlorhexidine.
⑷Pyrrolidone-iodine. It is a broad-spectrum antibacterial agent. It was previously used as a disinfectant for normal skin and mucous membranes. It has strong bactericidal power, but cannot penetrate eschar. 1. Water-soluble cream can be used on large and medium-sized burn wounds. Side effects include hyperiodineemia (increased T4 value) and metabolic acidosis.
⑸ Para-chloro-meta-xylenol (PCMX): The use of 5-p-chloro-meta-xylenol (PCMX) cream for external application is more effective against Staphylococcus aureus and can make up for the deficiency of silver sulfadiazine.
⑹Aminoglycoside antibiotics: 0.1 gentamicin sulfate solution and 0.5 neomycin solution for external use can penetrate the eschar and have a bactericidal effect. In severe infections, the concentration of antibiotics can be increased, but attention should be paid to Kidney and auditory nerve damage, and the emergence of drug-resistant strains have also limited its effectiveness.
⑺ Iodohydrin: It has significant killing effect on drug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, mold, etc. Iodohydrin is a hydrophilic drug. Iodohydrin aqueous solution is easy to use clinically and has no irritation to the skin and mucous membranes. Generally, 0.5% iodohydrin is used for semi-exposure therapy, and it can also be made into a low concentration for debridement and disinfection. Iodohydrin has good antibacterial effect and is a good external medicine for treating second-degree burn wounds.