Topical chemoprophylaxis with silver sulphadiazine and silver nitrate chlorhexidine creams: emergence of sulphonamide-resistant Gram-negative bacilli.

Controlled trials of 0.5% silver nitrate compresses (SN), 1% silver sulphadiazine cream (SSD), and a cream containing 0.5% silver nitrate and 0.2% chlorhexidine digluconate (SNC) showed that all were comparably effective in protecting burns from infection. SN compresses were much less active against miscellaneous Gram-negative bacilli than the other preparations, and the mean morning and evening temperatures and respiration rates in the patients treated with SN compresses were higher then those of patients treated with SSD. Pseudomonas aeruginosa and Proteus spp, though rare in all groups, were less often found in the patients treated with SN compresses. Sulphonamide-resistant Gram-negative bacilli became predominant during the trial of SSD cream on extensive burns and the prophylactic effectiveness of that preparation was thus reduced in the later stages of the trial.