Comparison of Silver Sulfadiazine, Povidone‐Iodine and Physiologic Saline in the Treatment of Chronic Pressure Ulcers

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Abstract
The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 105 or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone-iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100% of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 105 or less per gram of tissue within the 3 wk test period, compared to 78.6% in those treated with saline (14 patients) and 63.6% in those treated with povidone-iodine solution (11 patients). Ulcers treated with silver sulfadiazine cream responded more rapidly, with 1/3 showing bacterial levels of < 105 within 3 days, and half within 1 wk.

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