122-126 (460) napoli_ PAGINA TIPO

The debate on the use of antiseptics or antibiotics in the local antibacterial treatment of burns is still open. In general, it is believed that antibiotics are responsible for the selection of resistant strains, while the same cannot be said of antiseptics when both antibiotics and antiseptics are applied to lesions in insufficient concentrations. The current literature offers many studies on the toxicity and the limitations of the antimicrobial effectiveness of the principal antiseptics used until the present day. For example, we know that in burns covering more than 20% of the total body surface area (TBSA), povidone iodine interferes with thyroid function and may cause metabolic acidosis owing to kidney poisoning, which can even be fatal. In addition, it cannot be used on “secreting” burns, since being inhibited by organic substances (including blood) it loses its antibacterial effectiveness. It may also not be active against “epidemic” methicillinresistant Staphylococci aurei (E-MRSA) and Pseudomonas, as it is subject, among other things, to contamination by opportunistic pathogens of the Pseudomonadaceae family (Burkholderia Cepacia, formerly known as Pseudomonas Cepacia). With regard to mafenide acetate, we know that the inhibition of carbonic anhydrase that it causes at the level of the renal tubules leads to excretion of bicarbonate and chlorine, with consequent metabolic acidosis and compensatory hyperventilation. In the late 1970s higher mortality was reported in relation to respiratory complications following treatment of burns in over 30% TBSA. In the early 1970s descriptions began to appear of superinfections, due especially to Providencia Stuartii (Enterobacteriaceae), that were resistant to treatment with antibiotics. Superinfections caused by fungi were also observed. According to Monafo, these superinfections were the result of the considerable selection caused by routine use of mafenide acetate. The history of the use of silver as an antiseptic in the treatment of burns since the mid-1960s until the present day is emblematic.