trimethoprim--sulfamethoxazole-drug-combination and Burns

Infection of burn wounds is a serious problem because it can delay healing, increase scarring and invasive infection may result in the death of the patient. Antibiotic prophylaxis is one of several interventions that may prevent burn wound infection and protect the burned patient from invasive infections.. To assess the effects of antibiotic prophylaxis on rates of burn wound infection.. In January 2013 we searched the Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (2013); Ovid EMBASE; EBSCO CINAHL and reference lists of relevant articles. There were no restrictions with respect to language, date of publication or study setting.. All randomised controlled trials (RCTs) that evaluated the efficacy and safety of antibiotic prophylaxis for the prevention of BWI. Quasi-randomised studies were excluded.. Two review authors independently selected studies, assessed the risk of bias, and extracted relevant data. Risk ratio (RR) and mean difference (MD) were estimated for dichotomous data and continuous data, respectively. When sufficient numbers of comparable RCTs were available, trials were pooled in a meta-analysis to estimate the combined effect.. This review includes 36 RCTs (2117 participants); twenty six (72%) evaluated topical antibiotics, seven evaluated systemic antibiotics (four of these administered the antibiotic perioperatively and three administered upon hospital admission or during routine treatment), two evaluated prophylaxis with non absorbable antibiotics, and one evaluated local antibiotics administered via the airway.The 11 trials (645 participants) that evaluated topical prophylaxis with silver sulfadiazine were pooled in a meta analysis. There was a statistically significant increase in burn wound infection associated with silver sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to 3.19, I(2) = 0%). These trials were at high, or unclear, risk of bias. Silver sulfadiazine was also associated with significantly longer length of hospital stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to 2.28).Systemic antibiotic prophylaxis in non-surgical patients was evaluated in three trials (119 participants) and there was no evidence of an effect on rates of burn wound infection. Systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia (only one trial, 40 participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59 participants) (RR = 0.43; 95% CI: 0.12 to 1.61).Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of this review.Selective decontamination of the digestive tract with non-absorbable antibiotics had no significant effect on rates of all types of infection (2 trials, 140 participants). Moreover, there was a statistically significant increase in rates of MRSA associated with use of non-absorbable antibiotics plus cefotaxime compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).There was no evidence of a difference in mortality or rates of sepsis with local airway antibiotic prophylaxis compared with placebo (only one trial, 30 participants).. The conclusions we are able to draw regarding the effects of prophylactic antibiotics in people with burns are limited by the volume and quality of the existing research (largely small numbers of small studies at unclear or high risk of bias for each comparison). The largest volume of evidence suggests that topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared with dressings or skin substitutes; this evidence is at unclear or high risk of bias. Currently the effects of other forms of antibiotic prophylaxis on burn wound infection are unclear. One small study reported a reduction in incidence of pneumonia associated with a specific systematic antibiotic regimen.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bandages; Burns; Humans; Randomized Controlled Trials as Topic; Silver Sulfadiazine; Skin, Artificial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Patients with severe burns are at increased risk of developing methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia. This study was designed to determine whether MRSA pneumonia can be prevented by prophylactic administration of trimethoprim-sulfamethoxazole (TMP-SMX).. We conducted a prospective, randomized, placebo-controlled study in patients with severe burns (> or = 20%), who required ventilator support. Prophylaxis was done with oral TMP-SMX (80 mg/400 mg) three times daily for 10 days from 4 to 6 days after burn injury. The incidence of MRSA pneumonia and the side effects were evaluated during the administration period.. Twenty-one patients were assigned to receive TMP-SMX, and 19 patients to receive placebo. The incidence of MRSA pneumonia was 4.8% in the TMP-SMX group and 36.8% in the placebo group, showing a significant difference (p = 0.017). No major side effects of therapy were seen in the TMP-SMX group.. Prophylactic treatment with TMP-SMX can prevent MRSA pneumonia in severely burned patients.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Burns; Child; Cross Infection; Drug Monitoring; Female; Humans; Incidence; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Staphylococcal; Prospective Studies; Respiration, Artificial; Trimethoprim, Sulfamethoxazole Drug Combination

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are severe and potentially lethal adverse drug reactions characterized by acute inflammation of the skin, mucous membranes, and ocular surface that typically occurs within weeks of a culprit drug ingestion. The purpose of this study is to report a retrospective trend analysis of SJS spectrum diagnoses and associated culprit drugs in patients admitted to the Loyola University Medical Center (LUMC) Burn Unit, the major referral center in the Chicagoland region for patients with SJS disease spectrum.. The electronic medical records (EMR) of 163 patients with a diagnosis of SJS/TENS admitted to the LUMC Burn Unit from 2000 to 2019 were reviewed. Clinical data in addition to the well-established algorithm of drug causality for epidermal necrolysis (ALDEN) allowed us to identify the single most probable culprit drug in 131 cases.. From 2000 to 2019, the most common spectrum classification was TENS (48.1%), followed by SJS (33.6%) and SJS-TEN Overlap Syndrome (18.3%). Anticonvulsants were found to be the most probable culprit class in 30% of cases followed by Trimethoprim-Sulfamethoxazole in 19% of cases. Beta-lactams were the most probable culprit class in 11% of cases while NSAIDs and allopurinol were each the most probable culprit class/drug in 8.4% of cases.. This is one of the largest single center series of SJS/TENS cases in the United States. Further study into culprit drug distribution by region as well as continuous monitoring of trends is crucial in order to advise prescribing practices.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; beta-Lactams; Burn Units; Burns; Humans; Retrospective Studies; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral co-trimoxazole and amphotericin B were added to the regimen. The addition of co-trimoxazole decreased the incidence of Enterobacteriaceae wound colonization from 71 per cent to 11 per cent (P less than 0.005). Colonization with Proteus was eliminated in patients treated with co-trimoxazole, compared with an incidence of 36 per cent in the group treated with polymyxin alone (P less than 0.001). The addition of amphotericin B decreased yeast colonization of the burn wound from 39 per cent to 10 per cent (P less than 0.005). A close relation was observed between burn wound colonization and colonization of the gastrointestinal tract. No resistant bacterial strains emerged during the period of study. These results suggest that SDD is an effective method for prevention of wound colonization. Further controlled studies are needed to establish the role of SDD in preventing burn wound colonization and wound sepsis.

Topics: Adult; Amphotericin B; Burns; Digestive System; Drug Therapy, Combination; Humans; Middle Aged; Polymyxin B; Proteus; Proteus Infections; Pseudomonas; Pseudomonas Infections; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

An oral prophylactic antibiotic regimen aiming at suppression of the gram-negative rods and yeasts of the bowel flora was utilised in 48 severely burned patients to prevent burn wound colonisation. Only 17% of the patients had an actual or potential infection. Only one Pseudomonas infection occurred. The effect of this selective gastro-intestinal decontamination is discussed.

Topics: Adult; Amphotericin B; Anti-Infective Agents; Burns; Digestive System; Drug Combinations; Drug Therapy, Combination; Humans; Polymyxins; Sulfamethoxazole; Tobramycin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

The Minimal Inhibitory Concentration (MIC) and the Nathan's Agar Well Diffusion (NAWD) tests are bacterial antimicrobial susceptibility predictors. Some suggest that the NAWD is not as reliable as the MIC test. We compared the MIC and NAWD tests as to how well they agree to bacterial sensitivity or resistance and predicted clinical outcome of burn wound infections. Using 65 bacterial isolates from burned patients, the MIC and NAWD tests agreed in 60.0% of the isolates (vs. a perfect agreement of 100%, p less than 0.001), implying that these tests are not interchangeable. From 18 burned patients treated with nitrofurazone or mafenide acetate, 28 infectious isolates were evaluated. The outcome of these infections was correctly predicted by NAWD in 92.8% and the MIC in 72.0% of the cases (p less than 0.05). It seems that for burns treated with topical antimicrobials, the NAWD is a more reliable predictor of bacterial susceptibility.

Topics: Bacteria; Burns; Drug Combinations; Humans; Microbial Sensitivity Tests; Nitrofurazone; Predictive Value of Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

This is a case report of a patient who developed severe drug eruptions suspected to have been caused by sulphamethoxazole-trimethoprim (ST) administered orally for the treatment of urinary infection after burn injury. He had been treated topically with silver sulphadiazine (AgSD) after injury. The immunological examinations revealed positive reactions to both drugs, so that it is surmised that AgSD created the sensitivity and might be concerned in these drug eruptions. For such reasons, it is advisable, especially in patients who have been previously treated with topical or oral sulphonamides or have had episodes of hypersensitivity to such drugs, to administer sulphonamides carefully, or if possible to avoid administration.

Topics: Adult; Anti-Infective Agents, Urinary; Burns; Drug Combinations; Drug Eruptions; Humans; Male; Patch Tests; Silver Sulfadiazine; Staphylococcal Infections; Sulfadiazine; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Allopurinol; Burns; Critical Care; Drug Combinations; Emergencies; Female; Humans; Middle Aged; Phenylbutazone; Stevens-Johnson Syndrome; Sulfamethoxazole; Trauma Centers; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Topical; Bacteria; Burns; Drug Combinations; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination