Infection, especially with Pseudomonas aeruginosa and some other Gram-negative bacilli, is a major cause of death in severely burned patients. In attempts to combat such infection classical asepsis and systemic chemotherapy have been less successful than local chemoprophylaxis. Creams containing polymyxin, neomycin and some other antibiotics help, but compresses of 0.5% silver nitrate solution,1 2 and gentamicin cream3 4 appear to be better. Unfortunately silver nitrate gives little or no protection against Klebsiella and some other Gram-negative bacilli and is relatively ineffective against established infection: prophylactic use of gentamicin is likely in the long run to select out resistant strains of Ps. aeruginosa, and is therefore better reserved for the treatment of systemic pseudomonas sepsis. Two newer agents for local antimicrobial prophylaxis and treatment are mafenide acetate cream5 and silver sulphadiazine cream which is not yet marketed.6
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