Burn wound sepsis remains the leading cause of mortality if conservative methods of
wound management are employed. Topical agents are still the mainstay of such
wound management in the developing world. Non availability of agents like
Mafenide or
silver ion dressings in the developing world due to corporate strategies or cost concerns necessitates a search for alternatives to
silver sulphadiazine, which is the gold standard. We report the use of
framycetin 1% cream (
Soframycin) in 20 patients of major
burns (ranging from 15% to 40% TBSA), and in a double blinded study quantitatively comparing the bacterial load on day 4 and day 7 with a group of similar patients in whom
silver sulphadiazine was used. The age group of the 40 patients was 10-50 years and they were without any co-morbid condition. All bacterial isolates from the 40 patients were also tested for
framycetin sensitivity. Serial kidney function tests were done on all patients, and patients in the
framycetin group underwent an audiometric testing at a mean time of 28 days. All results were statistically analyzed. It was noted that there was no statistically significant difference in the colony counts on days 4 and 7 between the two groups. As a corollary, it was also evident that there was no statistically significant difference in the rise in colony counts from day 4 to day 7 in the two groups. Sixty-four percent of all bacterial isolates were sensitive to
framycetin, although, this could not be compared with sensitivity to
silver sulphadiazine. It was not possible to do assays for
framycetin levels in blood but no patient developed nephrotoxicity or
ototoxicity with its use. According to our pilot study results
framycetin appears to be an alternative to
silver suphadiazine as a topical agent for major
burns.
Framycetin application is also painless and it leads to no discoloration of the
wound.