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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers


Official Journal of the Italian Association for Cutaneous Ulcers
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Acta Vulnologica 2013 June;11(2):83-9

language: English, Italian

Rationale for the use of silver sulfadiazine in the treatment of infected chronic skin wounds

Giraldi E. 1, Zorzi L. 2

1 Centro Regionale Specializzato Multidisciplinare di Day Surgery, Padua Hospital, Padua, Italy;
2 Distretto Socio-Sanitario “De Rossignoli” Camposampiero, Padua, Italy


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Control of wound bed bioburden is essential for healing of chronic skin ulcers, including leg ulcers, pressure ulcers, and diabetic ulcers. Clinically, bacterial load manifests itself differently depending on its extent and interaction with the host. Bacteria may contaminate and colonize the wound without harm, whereas critical colonization and infection are abnormal states that require antimicrobial treatment. Local antimicrobial treatment is indicated especially in critical colonization. Silver sulfadiazine, the standard topical antibiotic in the control of bacterial load in the prophylaxis and treatment of skin infections, is listed in the World Health Organization Model List of Essential Medicines. Initially used in burn wound care, it was demonstrated effective also in the treatment of venous ulcers, diabetic ulcers, and pressure ulcers in particular. According to the U.S. Agency for Health Care Policy and Research – Clinical Practice Guidelines (AHCPR), silver sulfadiazine has the highest level of evidence (level of evidence A) for the treatment of infections caused by Gram-positive, Gram-negative, and anaerobic bacteria. In addition to reducing bacterial load thanks to the synergistic action of sulfadiazine and silver on various sites of the bacterial cell, it provides ideal hydration of the wound surface, creating a favorable environment for rapid epithelial regeneration and preventing the formation of eschar.

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