CA1216520A - Compositions for treating infected burn wounds - Google Patents

Abstract

Abstract Improved compositions for treating infected burn wounds A pharmaceutical composition comprises in admixture with a pharmaceutically acceptable vehicle or carrier, a thera-peutically effective amount of a silver compound suitable for treating burns, preferably silver sulphadiazine, and a synergistic amount of dibromopropamidine or pharmaceutically acceptable salts thereof, preferably the isethionate or pamoate.

Description

"Improved Compositions for Treating Infected Burn Wound~"
This invention relateæ to lpharmaceutical compoæitions containing silver compounds. More particularly it relates to silver compounds ~uitable for use in the treatment of burn wound infection.
Silver sulphadiazine is the most commonly used compound in pharmaceutical compositions for treating patients having burn wounds infected by Pseudomonas aeru~ nosa, Enterobacter cloacae and Staphylococcus aureus. However the . ~ .
activity of silver sulphadiazine in controlling these infections is less than optimum.
Gayle et al, 1978 (Journal of Trauma, 18, 317-323) _ _ _ reported 15 cases of silver sulphadiazine resistant Enterobacter cloacae in one burn~ unit and 13 of the lG patients died. Of these deaths 7 were directly caused by, and 2 others significantly related to E cloacae ~epticaemia.
An object of the present invention is to enhance the antimicrobial activity of silver compounds suitable for use in the treatment of burn wound infection.
According to the present invention there is provided a pharmaceutical composition cormprising in admix-ture with a pharmaceutically acceptable vehicle or carrier, a therapeutically effective amount of a ~ilver compound ~uitable for treating burns and a synergistic amount of dibromopropamidine or pharmaceutically acceptable salts thereof.
Preferably the pharmaceutical composition contains silver sulphadiazine and one of dibromopropamidine, dibromo-propamidine isethionate B. P. 1980 or dibromopropamidine pamoate. The dibromopropamidine or salts thereof may be present in concentrations of 0. 00015 to 0. 30 per cent w/w in ~"~ ~

pharmaceutical formulations OI silver ~ulphadiazine at 0. al to

2, 0 per cent w/w.
Sirnilar concentrations with preparations containing other silver salts are found to enhance the activity of these preparations which may infect the burn wound.
The dibromopropamidine salts have been proposed for use as topical antibacterials (BPC 1980 and Martindale, The Extra Pharmacopoeia, 1977, 27th Edition, Pharmaceutical Pre~s, Lontlon p. 517) but the synergistic effect exhibited in combination with sil~er salts is wholly unexpected. Thus greater antibacterial activity i~ obtained against all organisms tested than is observed with silver salts used alone at equivalent concentrations. The combination of dibromopropamidine isethionate 0.15% with silver sulphadiazine 1. 0% also possesses activity against the silver re~istant Pseudomonas aeru~inosa R 351 against which silver sulphadiazine 1. O~o alone has no activity, The Minimum Inhibitory Concentration of ~Ag+~alone against this strain of Pseudomonas aeruginosa is 12B pg ml 1 Exampleæ are given in Table 1 of the in vitro enhancement of activity when cream formulations were tested in duplicate by the agar diffusion method against an inoculum of approximately 5 x 10 organisms ml of test organism. The test organisms used were Pseudomonas aeruginosa NCTC 6750, Staph~ococcus aureus NCTC 6751, Enterobacter cloacae NCTC
_, _ 939~ and NCTC 10005.
Typically the compositions of this inventlon are prepared as topical antibiotic preparations in for example a water-miscible cream such as Cetomacrogol cream BPC 1968, or modifications of such a cream, or into a gel such as can be prepared from a dispersion of carbomer tCarbopal*940, Honeywell and Stein Ltd. ) by neutralising with dilute ammonia solution. Gel *Trade Mark ~t . ~_--~ ~ __ __ ~ o~ o a~

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formulations show a greater aetivity than equivalent cream formulations when tested by the agar diffusion method. This activity is shown by larger zones of inhibition of the order of 2-4 mm with the gel formulations. The gel also has the advantage that it can be st~rilised by heating in an autoclave at 115 C for 30 minutes.
The preparation is applied to the cleansed and debrided burn wound to give a layer approximately 2 to 4 mm thick. If left exposed the cream gel is applied twice daily but when used under an occlusive dressing then it may be applied at daily or longer intervals, according to the condition of the wound, until satisfactory healing has occured or the burn site is ready for grafting.

Claims (5)

The embodiments of the invention in which an exclusive property or privilege is claimed are defined as follows.

1. A pharmaceutical composition comprising in admixture with a pharmaceutically acceptable vehicle or carrier, a thera-peutically effective amount of a silver compound suitable for treating burns and a synergistic amount of dibromo-propamidine or pharmaceutically acceptable salts thereof.

2. A composition according to claim 1 which contains silver sulphadiazine and one of dibromopropamidine, dibromo-propamidine isethionate B.P. 1980 or dibromopropamidine pamoate.

3. A composition according to claim 2 wherein the dibromo-propamidine or salts thereof are present in concentrations of from 0.00015 to 0.30 per cent w/w in pharmaceutical formulations of silver sulphadiazine at 0.01 to 2.0 per cent w/w .

4. A composition according to claim 1 which contains 0.15%
dibromopropamidine isethionate and 1% silver sulphadiazine.

5. A composition according to claim 1 wherein the vehicle is an aqueous carbomer dispersion gel.