Effective topical
antimicrobial agents decrease
infection and mortality in
burn patients.
Chlorhexidine phosphanilate (CHP), a new broad-spectrum
antimicrobial agent, has been evaluated as a topical
burn wound dressing in cream form, but preliminary clinical trials reported that it was painful upon application. This study compared various concentrations of CHP to determine if a tolerable concentration could be identified with retention of antimicrobial efficacy. Twenty-nine
burn patients, each with two similar
burns which could be separately treated, were given pairs of treatments at successive 12-h intervals over a 3-day period. One
burn site was treated with each of four different CHP concentrations, from 0.25 per cent to 2 per cent, their vehicle, and 1 per cent
silver sulphadiazine (AgSD) cream, an
antimicrobial agent frequently used for topical treatment of
burn wounds. The other site was always treated with AgSD cream. There was a direct relationship between CHP concentration and patients' ratings of
pain on an analogue scale. The 0.25 per cent CHP cream was closest to AgSD in
pain tolerance; however, none of the treatments differed statistically from AgSD or from each other. In addition, ease of application of CHP creams was less satisfactory than that of AgSD. It was concluded that formulations at or below 0.5 per cent CHP may prove acceptable for
wound care, but the vehicle system needs
pharmaceutical improvement to render it more tolerable and easier to use.