Methemoglobinemia by cerium nitrate poisoning
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Keywords:
Methemoglobinemia
Cerium nitrate
Silver sulfadiazine
Methylene blue
Silver nitrate
Antiseptic
The role of silver and sulfadiazine in the mechanism of action of silver sulfadiazine on burn wound infections was investigated. Silver, but not sulfadiazine, was bound by bacteria. Sulfadiazine did not act as an antibacterial agent in low concentrations, but exhibited specific synergism in combination with subinhibitory levels of silver sulfadiazine. The efficacy of silver sulfadiazine is thought to result from its slow and steady reactions with serum and other sodium chloride-containing body fluids, which permits the slow and sustained delivery of silver ions into the wound environs. In this circumstance, a relatively minute amount of sulfadiazine appears active.
Silver sulfadiazine
Mechanism of Action
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Sulfonamide-resistant organisms have been reported as a frequent consequence of the clinical use of sulfadiazine silver. At this burn center, sulfonamide resistance occurred in more than 80% of gram-negative isolates. We tested the requirement for the individual antimicrobial activities of sulfadiazine and silver for the vitro activity of sulfadiazine silver. The sulfadiazine component is not necessary for in vitro sensitivity. In vitro sensitivity to sulfadiazine silver does not consistently predict the presence of therapeutic activity in Pseudomonas aeruginosa-infected rats with burns. We describe an example of a transferable multiple-antibiotic resistance plasmid that contains selectable sulfonamide resistance. The use of sulfadiazine silver can, therefore, lead to the selection of organisms that are resistant not only to sulfonamides but to antibiotics of clinical consequence, and this possible risk must be considered in electing to use the agent.
Silver sulfadiazine
Sulfonamide
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Objective: To prepare the collagen burn pellicle of compound sulfadiazine sliver and to investigate the influencing factors of drug release. Methods:The collagen burn pellicle of compound sulfadiazine sliver was prepared by initator method,the release percent was determined by paddle method. Results:A milky white, translucent, smooth and elastic membrane was prepared. The maximal release percent of the collagen burn pellicle of compound sulfadiazine silver was achieved under the conditions of 0.3 mL cross linking agent, 3 hours of cross linking time at 37 ℃ and 3 hours at constant temperature. Conclusion:The collagen burn pellicle of compound sulfadiazine sliver can be easily prepared by initator method.This method is accurate,rapid and simple for the quality control of the collagen burn pellicle of compound sulfadiazine silver.
Silver sulfadiazine
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Previous studies have indicated that combining cerium nitrate with silver sulfadiazine (Silvadene, Marion Labs) yields a superior topical agent for the treatment of burns. Cerium nitrate in silver sulfadiazine was tested in a controlled study with silver sulfadiazine alone. The study population consisted of two groups of children suffering burns greater than 30% of the body surface. The patients ranged in age from 1 to 21 years. The study period was for the first 10 weeks of hospitalization. Quantitative surface cultures were used to monitor burn wound flora. No superiority for the silver sulfadiazine-cerium nitrate combination was demonstrated. In fact, cultures indicate a significantly greater percentage of Gram-negative pathogens in patients treated with the cerium mixture. Cerium nitrate could possibly prove of greatest benefit if used as a reserve therapy for colonizing organisms which do not routinely respond to silver sulfadiazine.
Silver sulfadiazine
Cerium nitrate
Silver nitrate
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Sulfadiazine-loaded silver nanoporous silica carriers have similar antibacterial properties as silver sulfadiazine.
Silver sulfadiazine
Nanoporous
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Isolates (657) representing 22 bacterial species were tested for susceptibility to silver sulfadiazine. All of the strains tested were inhibited by concentration levels of the drug which are easily achieved topically. It is suggested that silver sulfadiazine may be useful as a broad-spectrum antimicrobial substance for the prevention and treatment of infections of burns and wounds.
Silver sulfadiazine
Broad spectrum
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Silver sulfadiazine-resistant organisms are arising at an irregular rate and may eventually interfere with wound management. To counter this problem several new antibacterial agents were tested in combination with silver sulfadiazine. Only sodium piperacillin (Pipracil, Lederle) exhibited synergism with silver sulfadiazine both in vitro (against various species of organisms) and in burned animals. The MIC of AgSD and Pipracil was 50 nmole/ml and 250 nmole/ml, respectively, but a combination of 6 nmole/ml of AgSD and 7.5 nmole/ml of Pipracil inhibited the growth of Pseudomonas aeruginosa. In burned mice infected with either AgSD-resistant or sensitive strains, the mortality in groups receiving combinations of topical Pipracil and silver sulfadiazine was 0-10%; in contrast, treatment with Pipracil or silver sulfadiazine alone resulted in much higher mortality. Thus it would appear that a combination of silver sulfadiazine and Pipracil, each of which have long been used in patients topically and parenterally, may prove valuable in patients with burn wound infections related to or caused by organisms resistant to silver sulfadiazine.
Silver sulfadiazine
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Objective To explore the therapeutic effects of heparin sodium and silver sulfadiazine in treating Type II depth burns.Methods 52 patients of Type II depth burns were treated in two different methods.The experimental group was treated with heparin sodium and silver sulfadiazine,and the contrast group was treated with silver sulfadiazine only.The healing time,the rate of infection and the scar hyperplasia indexes of the two groups were contrasted.Results The Average healing time and the infection rate were(18.2±3.62)days and 10% in the experimental group and(25.2±2.62)days in the contrast group.There existed significant differences in between the two groups(P0.01).Conclusion The combined use heparin sodium and silver sulfadiazine can produce much better therapeutic effects than using silver sulfadiazine only.
Silver sulfadiazine
Heparin sodium
Sodium bicarbonate
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The antimicrobial activity of cerium nitrate and silver sulfadiazine was assessed in vitro and in vivo using Pseudomonas aeruginosa. In vitro, the activity of silver sulfadiazine was significantly greater than that of cerium nitrate. Synergism between silver sulfadiazine and cerium nitrate was observed in water or saline solution suspensions, but not in broth. In vivo, cerium nitrate offered no therapeutic benefit in reducing wound infection in contaminated wounds. Treatment of similar wounds with silver sulfadiazine resulted in a significant decrease in wound infection and in the level of viable bacteria when compared with that for untreated controls. The addition of cerium nitrate to silver sulfadiazine in aqueous soultion reduced the therapeutic benefit of silver sulfadiazine.
Silver sulfadiazine
Cerium nitrate
Silver nitrate
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