What Is Sulfadiazine?

Sulfadiazine is white or off-white crystal or powder. It is odorless and tasteless. It gradually becomes dark when exposed to light. Almost insoluble in water, soluble in boiling water (1:60), slightly soluble in ethanol and acetone, insoluble in chloroform and ether, easily soluble in diluted hydrochloric acid, sodium hydroxide solution or ammonia solution. Melting point 252-256 ° C (simultaneous decomposition). Its sodium salt is white crystalline powder, odorless and slightly bitter. When encountering light gradient brown. In the humid air for a long time, it slowly absorbs carbon dioxide and precipitates sulfadiazine. Soluble in water, slightly soluble in ethanol, insoluble in chloroform and ether. The pH of a 10% aqueous solution is 9.5 to 10.5.

Sulfa levels should not

Sulfadiazine has a broad antibacterial spectrum with similar antibacterial effects to SMZ. Sulfadiazine has a low plasma protein binding rate (approximately 45%), and drugs with the highest cerebrospinal fluid barrier permeability can easily enter the cerebrospinal fluid, which has a prominent effect on the prevention and treatment of epidemic meningitis. It is often used clinically as the drug of choice for epidemic meningitis.

Shandong Health Pharmaceutical Co., Ltd., Jiangxi Pingxiang Pharmaceutical Factory, Anhui Fengyuan Pharmaceutical Co., Ltd., Shanghai Xinyi Pharmaceutical Co., Ltd., Sanjiu Wanrong Pharmaceutical Co., Ltd., Fuzhou Haiwang Fuzhou Pharmaceutical Co., Ltd., Guilin South, Guangxi Pharmaceutical Co., Ltd., New World Haitian (Xinyang) Yunan Pharmaceutical Co., Ltd., Northeast Pharmaceutical General Factory, Guangdong Nanguo Pharmaceutical Co., Ltd., Hubei Zhongtian Aibaigu Pharmaceutical Co., Ltd., Xi'an Fourth Pharmaceutical Factory, Hefei, Anhui Province Second Pharmaceutical Factory, Hefei Pharmaceutical Factory, Jiangsu Huanghe Pharmaceutical Co., Ltd., Lanzhou Dunhuang Pharmaceutical Factory, Kunming Healthcare Pharmaceutical Factory, Xi'an Great Wall Pharmaceutical Factory, Xianyang Second Pharmaceutical Factory in Shaanxi Province, Chongqing Kerui Pharmaceutical Co., Ltd., Southwest Synthetic Pharmaceutical Co., Ltd., Sichuan Synthetic Pharmaceutical Co., Ltd., Guizhou

The vast majority of patients encountered in the clinical treatment of burns are patients with degree to deep degrees.

Sulfadiazine Information and Methods

General information: 19 males and 16 females; aged 2 to 91 years, with an average of 39.13 ± 21.45 years, and 2 deaths. The length of hospital stay ranged from 2 to 49 days, with an average of 21.42 ± 5.34 days. The wounds had a minimum of 5% TBSA and a maximum of 95% TBSA. Twenty patients with severe bullous epidermal necrolytic drug eruption had more than 90% of the body's skin loosening and blisters. After healing, the time of rash and swelling subsided was 3 to 15 days (average 8.3 days), and the scab time of the skin erosion and erosion surface was 6 to 14 days (average 9.6 days). All cases met the classification criteria established by the 9th Internal Classification of Diseases adapted (Ninth Modification).

Study object and group: 70 patients with bullous epidermolytic drug eruption were hospitalized and outpatient cases from March 1987 to January 2006. They were divided into experimental group and control group, of which 35 cases were experimental group. Treatment of burn wounds requires debridement, and silver sulfadiazine was applied to all wounds and blister or rotten skin; 35 cases of the control group, after sterilization with 0.3% iodophor, cut the blister at a low position, release the blister fluid, and irradiate with far infrared rays. All have been confirmed by clinical, laboratory and pathological diagnosis.

Statistical processing: All data were analyzed with SPSS8.0 software package. Results are expressed as mean ± standard deviation. The t-test was used to compare the means between two samples; the X2 test was used to compare the two sample rates. ^[1]

Sulfadiazine treatment and outcome

External application of silver sulfadiazine wounds: The skin wounds were thoroughly washed with 0.1 chlorhexidine, debrided as required, the blister was cut at the low level of the blister, the blister fluid was released, and the blister or rotten skin was retained. For wounds on the neck, perineum, etc., you can directly apply silver sulfadiazine to all wounds and blister or rotten skin with a thickness of about 1mm, once every 4 hours, for exposure therapy; or a layer of sterile gauze for semi-exposure Treatment; and irradiated with a baking lamp. Regularly check the fluid under the gauze daily and replace the gauze if necessary. Limbs and trunk wounds were coated with sulfadiazine silver 2mm for aseptic dressing (thickness during exudation period to prevent excessive exudation). The dressing was changed once a day during the exudation period. After 4 days, the rotten skin, blister skin, and thin soft membrane were simply cleaned up, and then immediately coated with silver sulfadiazine to protect the regeneration wound until the wound healed. If the wound is fresh and there are no signs of infection in the whole body or local area, the dressing can be changed once every 4 days; if the wound is infected, the dressing needs to be changed 1 to 2 times a day. For patients with finger or toe erosion, bandage each finger or toe separately to prevent adhesions. In accordance with the burn treatment plan, the ward implements a protective isolation system to strictly restrict escorts and visitors.

The comparison of the treatment effect between the experimental group and the control group is shown in Table 1: 26 cases (74.3%) were cured, 8 cases were effective (22.9%), 1 case was not effective (2.8%), and the total effective rate was 97.2%. In the control group, 7 cases (20.0%) were cured, 15 cases (42.9%) were markedly effective, 13 cases (37.1%) were ineffective, and the total effective rate was 62.9%. After statistical processing, X2 = 9.33, P <0.05, the total effective rates of the two groups were significantly different.

The comparison of wound application effects between the silver sulfadiazine group and the exposure therapy group is shown in Table 2: wound healing time, wound infection rate, mortality rate, occurrence of moderate scars, positive bacterial culture rate, and quantification of subcutaneous bacteria> 105 / g. There was a significant difference between the sulfadiazine silver group and the exposure therapy group after statistical processing P <0.05. ^[1]

Criteria for judging the efficacy of sulfadiazine

Healing was erythema subsided, all blisters had dried up and crusted, most of the crusts had fallen off, most of the skin lesions had healed, and there was no inflammatory reaction in the wound. The marked effect was that most of the erythema had subsided, some of the blisters had crusted, and some of the skin lesions had healed. Inflammatory response; ineffectiveness is erythema, blister subsidence is not obvious, skin lesions heal a little, and inflammatory response is severe around the wound. Wound healing time: refers to the time it takes for a patient to heal from the appearance of blisters until the scalp peels off completely. Unit: day (d) Wound infection rate: 1 case of infection was caused by purulent exudate or wound exudate cultured from the wound. Wound infection rate = number of infections / number of cases in the experimental or control group, recorded in%. Mortality = number of deaths / number of cases in the experimental or control group, recorded in%. Moderate scar occurrence rate: According to the degree of scar appearance, it can be divided into mild, moderate and severe. The rate of moderate scars = the number of cases of moderate scars / the number of cases in the experimental group or the control group, recorded in%. Bacterial culture positive rate: Under the same pollution degree and debridement condition, select the corresponding wounds with similar depth in the same patient according to the random principle, apply 1% silver sulfadiazine and / or boric acid respectively, and 5 The number of positive cases of bacterial culture within 7 days / the number of cases in the experimental group or the control group is recorded in%. The number of bacterial counts below 105 / g tissue: the number of bacterial counts above 105 per gram of coke. ^[1]

Sulfadiazine Expert Discussion

Domestic treatment of bullous epidermolytic drug eruption uses exposure therapy or moist burns ointment, 2% to 4% baking soda solution, sterile sage oil, 0.1% rifano solution, 3% boric acid solution, erythromycin ointment, Chloramphenicol powder, 0.1% Xin Jie Erfen solution and other external coating, but the above methods are not as good as antibacterial and pimple formation silver sulfadiazine. In the past, the treatment of bullous epidermolytic drug eruption erosive surfaces has often used exposed skin lesions to keep the wounds dry and even exposed to dry / dry exposure treatment under the infrared lamp cover. This therapy is often caused by dry stimulation due to lack of effective protection of the wounds. Wound pain is intolerable, and a large amount of fluid is lost from the wound, which is not conducive to the regulation of fluid balance in the whole body. Sulfadiazine silver, English Sulfadiazinmu Argenteum (abbreviated as SD-Ag) has a strong anti-infective power, and has a significant inhibitory effect on Staphylococcus aureus, Gram-positive bacteria, and Pseudomonas aeruginosa. Shedding and healing time was significantly shortened. Bullous epidermolytic drug eruption erosive surface is similar to second-degree burn wounds. Therefore, we have applied the successful experience of silver sulfadiazine in treating burn wounds to bullous epidermolytic drug rash and achieved the same good results. The silver sulfadiazine itself is non-irritating and does not cause additional damage to the wound. It is applied to the wound to isolate the air, avoid pain caused by dry irritation, and effectively prevent a large amount of water from evaporating, keeping the interstitial fluid and the internal environment stable, thereby reducing the amount of fluid replacement.

Silver sulfadiazine is an organic compound formed by the combination of sulfadiazine and silver nitrate. When silver sulfadiazine is in contact with tissues, it does not form a silver chloride precipitate, but slowly decomposes to release silver and sulfadiazine. It is in the tissue fluid for a long time. Maintaining a high concentration level is like setting up a drug storage bank on the wound surface, which can inhibit bacteria that continue to grow, so it is an ideal external medicine. The silver sulfadiazine penetrates the pyrophyllum to release silver ions and sulfadiazine, forming a thin layer of light gray on the wound surface, which can pass through the skin and dermis to reach deep vital fat tissue and accumulate on the wound surface and its deep It has anti-infective effect and has astringent effect, and promotes dry and scabby wounds. Most of the released silver ions are bound to the DNA of bacteria. The chemical structure of sulfadiazine and para-aminobenzoic acid is similar, which affects the synthesis of bacterial nucleic acids, thereby inhibiting the growth and reproduction of bacteria. Silver is unique among antimicrobials because of its broad spectrum of action. According to the American Scientific Abstracts in 1978, silver can kill 650 different pathogens. Montes LF et al. Found that silver sulfadiazine can inhibit the activity of human varicella zoster virus in vitro. Therefore, topical application of 1% sulfadiazine silver silver cream to 42 cases of herpes zoster has achieved significant results. The effect of silver sulfadiazine on varicella-zoster virus activity in vitro is related to silver ions. Silver sulfadiazine cannot be used in patients who are allergic to sulfa drugs, and those with impaired liver and kidney function should be used with caution. It should not be used in newborns to prevent the occurrence of nuclear jaundice in newborns. Sulfonamides are prone to drug resistance, and other broad-spectrum antibiotics need to be applied during treatment to effectively control infection.

Skin is an important part of the body's immune function. Patients with severe bullous epidermolytic drug eruption have a large skin area, large epidermal peeling, severe barrier function damage, prone to complications such as infection, and death in severe cases. Therefore, intensive wound treatment and active cooperation with systemic treatment can greatly reduce The course of the disease reduces the suffering of the patient. Bandaging facilitates the application of tourniquets directly on skin lesions during venipuncture and causes pain and skin avulsion. For the success of this disease treatment, the proper treatment of wounds plays a very important role, which is an important link that cannot be ignored in the treatment of this type of drug rash. Correct treatment of wounds is the key to preventing and controlling infections, reducing complications, reducing mortality, shortening treatment courses, and improving the success rate of rescue.

Topical silver sulfadiazine has the advantages of convenient use, quick response, and significantly shortened disease duration. Silver sulfadiazine is not only sterilizing, but also non-irritating to the skin, and also promotes the exudate to dry out and scab as soon as possible. The external application of sulfadiazine silver is simple and easy, and the clinical effect is good, which provides a new way for the treatment of bullous epidermolytic drug rash wounds. We use the method of treating shallow second-degree burns to treat bullous epidermolytic drug eruption. The external application of silver sulfadiazine to the skin lesions has significantly shortened the course of the disease, significantly reduced the infection rate and mortality, reduced scarring, good curative effect, quick effect, no Obvious side effects, compared with traditional therapies, statistical processing, the results are significantly different, it is worth popularizing. ^[2]