Chlorhexidine/silver sulfadiazine

Infection risk Catheter-related bloodstream infections pose a significant problem for hospitalized patients. In a randomized comparison in 960 patients of 5-fiuoruracil or chlorhexidine-I-silver sulfadiazine as central venous catheter coatings, 5-fluorouracil was non-inferior to chlorhexidine-b silver sulfadiazine with respect to the incidence of catheter colonization (2.9% versus 5.3%) [ll ]. Local site infections occurred in 1.4% with 5-fluoruracil and 0.9% with chlorhexidine + silver sulfadiazine. There were no episodes of catheter-related bloodstream infections with 5-fluoruracil but two episodes with chlorhexidine + silver sulfadiazine. The incidence of adverse events was low and comparable in the two groups. 

Walz JM, Avelar RL, Longtine KJ, Carter KL, Mermel LA, Heard SO. Anti-infective external coating of central venous catheters a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med 2010 38(11) 2095-102. 

Brun-Buisson C, Doyon F, Sollet JP, et al. Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters a randomized controlled trial. Intensive Care Med May 2004 30(5) 837 3. 

CHG = Chlorhexidine gluconate CHSS = chlorhexidine-silver sulfadiazine PVI = povidone iodine. ... 

A meta-analysis of the clinical and economic effects of chlorhexidine and silver sulfadiazine antiseptic-impregnated catheters has been undertaken (60). The costs of hypersensitivity reactions were considered as part of the analysis, and the use of catheters impregnated with antiseptics resulted in reduced costs. The analysis used the higher estimated incidence of hypersensitivity reactions occurring in Japan, where the use of chlorhexidine-impregnated catheters is still banned (61). 

Three classes of antimycotic antibiotic are available polyenes, azoles and nucleoside analogs. In addition, non-specific antimicrobial agents such as povidone iodine, chlorhexidine and silver sulfadiazine can be adapted for ophthalmic use. 

Topical 2% povidone iodine solution and 0.2% chlorhexidine gluconate solution have broad antimicrobial profiles and may be used as cheap spectrum and effective antifungal agents in equine ketomycosis, particularly where Fusarium spp. are involved. A1% dermatological cream formulation of silver sulfadiazine has both antifungal and antibacterial properties and is reasonably well tolerated topically in the horse eye. Its use is advocated where cost restraints exist or for prophylaxis in comeal injuries involving embedded plant material (Hamor Whelan 1999). 

Silver sulfadiazine is present on the external CVC surface chlorhexidine on the intraluminal CVC surface The antibiotics, present both onto the external and the internal CVC surface, are to the catheter surface through a TDMAC coating Drugs are adsorbed onto both catheter surfaces Sold under the trade name AMC Thromboshield , this catheter has the two bioactive agents onto both the internal and the external surfaces... 

In the early 2000s, the second-generation CH/SS-coated CVCs were marketed. These catheters have both surfaces coated with antimicrobials silver sulfadiazine is present on the external surface and chlorhexidine on the intraluminal surface. In addition, the concentration of chlorhexidine was three times higher than that present into the first-generation catheters. 

Bach A. Clinical studies on the use of antibiotic- and antiseptic-bonded catheters to prevent catheter-related infection. Zentralbl Bakteriol December 1995 283(2) 208-14. Greenfeld JI, Sampath L, Popilskis SJ, et al. Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit Care Med May 1995 23(5) 894-900. 

Ostendorf T, Meinhold A, Harter C, et al. Chlorhexidine and silver-sulfadiazine coated central venous catheters in haematological patients-a double-blind, randomised, prospective, controlled trial. Support Care Cancer December 2005 13(12) 993-1000. 

Rupp ME, Lisco SJ, Lipsett PA, et al. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections a randomized, controlled trial. Ann Intern Med October 2005 143(8) 570-80. Darouiche RO, Raad II, Bodey GP, et al. Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia potential role of the combination of minocycline and rifampin. Int J Antimicrob Agents September 1995 6(l) 31-6. 

---