Pharmacological properties

Pharmacodynamics. the mechanism of antimicrobial effect of sulphathiazole includes the oppression of growth and reproduction of microorganisms connected with competitive antagonism with paraaminobenzoic acid and oppression of a digidropteroatsintetaza that leads to disturbance of process of synthesis of dihydrofolic acid, and, finally, its active metabolite — the tetrahydrofolic acid necessary for synthesis of purines and pyrimidines of a microbic cell.

Sulphathiazole of silver has a wide range of antibacterial action against the mixed flora (gram-positive and gram-negative microorganisms), including Pseudomonas aeruginosa.

and considerably reduces the infecting ability of viruses of herpes and the surrounding herpes outside a cell.

Drug effectively protects a wound from infection, forms a protective layer on a wound surface, maintains adequate humidity and promotes wound healing.

Pharmacokinetics. Sulphathiazole of silver has the lowest degree of solubility among other silver salts of group of streptocides and also high stability. Low degree of solubility and high stability of sulphathiazole of silver allows to remain on a surface of an affected area of skin and to reduce absorption in blood. The absorbed sulphathiazole is acetylated in a liver then it is removed with urine in the form of inactive metabolites and partially — in not changed look. Absorption of sulphathiazole increases after use of medicament on considerable sites of the affected skin.

Indication

Burns of all severity of various origin (including thermal, solar, chemical, at defeat by electric current, beam) and also freezing injury.

Decubituses, trophic ulcers of shins of various genesis (including at chronic venous insufficiency, an obliterating endarteritis, disturbances of blood supply in diabetes, an ugly face).

Purulent wounds, home accidents (cuts, grazes).

Infected dermatitis, contact dermatitis, the complicated impetigo, microbic eczema, strepto- and a staphyloderma.

Use

Use in burns. medicament is intended for topical administration as in the open way, and with use of occlusive bandages. argosulfan does not cause darkening of skin and linen.

After cleaning and surgical treatment of a wound cream is put with a layer of 2-3 mm, meeting sterility conditions. All affected areas of skin have to be covered with cream during the entire period of treatment. If for any reason a part of a wound is not covered with cream, it is necessary to apply a thin film of medicament always in addition. There is no need to apply an occlusive bandage to a wound, except cases when there are indications for its use. To apply cream to a complete wound healing or till the moment when the surface of a wound is prepared for skin transplantation (surgical interventions).

Treatment of decubituses and trophic ulcers of a shin. Drug is applied with a thin layer on affected areas of skin by 2–3 times a day.

in case of putting medicament on contaminated wounds exudate can appear. In such cases before use of cream it is necessary to wash a wound of 0.1% with water solution of a chlorhexidin, 3% water solution of boric acid or other antiseptic agent. For adults the control of dosing is not obligatory.

Contraindication

Hypersensitivity to sulphathiazole, other streptocides or excipients and also a porphyria. congenital insufficiency glyukozo-6-fosfatdegidrogenazy.

Drug is usually well transferred by

.

Note irritation of skin which is shown by burning sensation in the site of application of cream. In case of prolonged use of the medicament Argosulfan, renal failures, including interstitial nephrite, dysfunctions of a system of a hemopoiesis, including an agranulocytosis, hemorrhagic diathesis, thrombocytopenia, aplastic and hemolytic anemia, a leukopenia can develop. In the site of application of cream the irritation and reactions of hypersensitivity, including burning, an itching, reddening are possible. Drug contains cetostearyl alcohol which can cause development of local skin reactions, including contact dermatitis. Drug contains propilparagidroksibenzoat, methylparahydroxybenzoate that can lead to development of allergic reactions.

should remember

At use of the medicaments containing silver sulphathiazole possibility of reaction of hypersensitivity, including Stephens's syndrome — Johnson, or other system side reactions characteristic of sulfonamides, including side reactions from a liver.

Special instructions

cross hypersensitivity to sulphonylurea derivatives, a benzotiazin and r-aminosalicylic acid Is possible

. in each case it is necessary to collect carefully the allergological anamnesis, especially concerning streptocides. to avoid contact of medicine with eyes and mucous membranes. at accidental hit to wash out enough water. development of the undesirable and system side effects characteristic of sulfonamides is also possible.

With care use medicament at the patients who are in a state of shock after extensive burns or patients after burns to which it is difficult to contact. Cumulation of medicament and emergence of side reactions at patients with an abnormal liver function and kidneys is possible.

Against the background of prolonged use on big sites of skin should control sulphathiazole level in blood plasma, especially in cases of diseases of kidneys and a liver and also the level of leukocytes as development of an agranulocytosis or anemia is possible.

Use during pregnancy and feeding by a breast. Safety of use of Argosulfan medicine during pregnancy was not studied. Researches on animals of influence of sulphathiazole of silver on fetation were not conducted. Controlled researches on influence at topical administration of medicament on fetation were not conducted. It is not recommended to use medicament during pregnancy, except for cases when the expected advantage for mother exceeds potential risk for a fruit.

Does not know to

whether sulphathiazole of silver or its metabolites gets into breast milk. It is known that sulfonamides for oral administration can get into breast milk and cause manifestations of jaundice in children.

is not recommended to use medicament during feeding by a breast.

Children. Drug can be used at children aged from 3 months

Ability to influence speed of response at control of vehicles or work with other mechanisms. Argosulfan does not affect ability to run vehicles or to use mechanisms.

Interaction

Drug is not recommended to be used along with other medicines of local action for prevention of a possibility of their interaction.

At system use folic acid or derivatives of r-aminosalicylic acid (for example Procainum) can weaken antibacterial effect of sulphathiazole of silver.

, but is improbable as silver salts of sulfonamides affect mainly a cell membrane, but not on metabolic processes (but such effect cannot be excluded).

during simultaneous treatment by Cimetidinum (the leukopenia is noted 20 times more often in case of a combination with Sulfadiazinum).

Overdose

About cases of overdose it was not reported. absorption through the injured skin or increase in expressiveness of the side reactions characteristic of Sulfadiazinum is possible.

Storage conditions

At a temperature not above 25 °C. not to freeze.

Relevant information

it is long not healing wounds of various origin For today are an important problem in medicine. decubituses and trophic ulcers significantly worsen quality of life of the patient. besides morbidity and esthetic discomfort, it is long the existing wound surface becomes a constant source of development of chronic inflammatory reactions that, in turn, can lead to exacerbation of associated diseases. besides, the microorganisms which are in a wound can pose a direct threat of life and to human health as can become the reason of septic complications.

Problem it is long not healing wounds and decubituses it is especially relevant for bed patients irrespective of whether the patient of senile age reached or the person of young, or middle age is immobilized during the long span. Decubituses create discomfort both for the patient, and for those who look after him. For this reason medicament which would simplify process of care for a wound surface and would accelerate its healing is necessary. Cream Argosulfan whose efficiency is connected with the active ingredient which is its part can be such drug.

In what cases applies by Argosulfan :

• Argosulfan is recommended for treatment of all types of burns of skin — thermal, electric, beam, chemical (after elimination of a disturbing factor) and also for processing of local frostbites of skin (for example after removal of superficial new growths by liquid nitrogen). Drug can be used before full healing of a burn wound or until readiness of the patient for transplantation of a skin rag. And this method proved for a long time — occlusive bandages with sulphathiazole are applied since the first half of the XX century (Ackman D., 1944);

• besides, the knitting properties of silver (Fox C.L., 1979) allow to use medicament for treatment of superficial burns of skin even if the patient asked for medical care not at once and the burn wound is already infected;

• the excellent effect in healing of trophic ulcers is observed at a research of laboratory model of diabetic foot — difficult multicomponent pathological process in which the important part is assigned to a mikroangiopatiya (to disturbance of a capillary blood-groove in soft tissues). Silver reduces quantity of a wound detritis and accelerates epithelization of wound defect, and sulphathiazole interferes with growth of opportunistic microflora (Zinov’ev E.V., 2014);

• also the good therapeutic effect in trophic ulcers of the lower extremities of not diabetic genesis is observed (for example a heavy complication of a posttromboflebitichesky syndrome, chronic venous insufficiency or an obliterating endarteritis) (Filipiuk J., 1978);

• Argosulfan is effective for treatment of decubituses. However decubitus is a difficult pathology which cornerstone the disturbance of protective properties and a trophicity of soft tissues is because the same sites are constantly squeezed under the body weight of the lying person. Therefore treatment by the combined antibacterial medicament has to be combined surely with the maximum activization of the patient (or regular change of position of a body in a bed) and also special devices (pillows, mattresses) for redistribution of loading;

• sulphathiazole of silver can be applied at damage of skin by viruses of herpes of the 1- or 2nd type (Stozkowska W., 1999) — in researches is shown that 30-minute exposure of medicament completely inactivates a virus. At the same time silver provides direct antiviral effect, and sulphathiazole interferes with suppuration or accession of a bacterial infection. Also in literature the activity of sulphathiazole against a virus of herpes of the 8th type which causes Kaposi sarcoma is described (Angius F., 2017);

• by analogy with other sulfatiazolsoderzhashchy medicaments (Ackman D., 1942) Argosulfan can will be applied in gynecologic practice. For the maximum therapeutic effect it is necessary to combine local antibacterial therapy (Fogli I.C., 1954) with system use of medicaments taking into account sensitivity of the activator (Borno R., 1958). Information on a possibility of use of the similar scheme for treatment of a gonorrheal vulvovaginitis is published (Greig G.H., 1941);

• as sulphathiazole is active against stafilokokk and streptococci, medicament can be used as supportive application at a fistular form of osteomyelitis (Basch F., 1949) — it is put in a fistula cavity. In an experiment on dogs it was proved (Summers L., 1976) that at contact with a periosteum and adjacent fabrics sulphathiazole has the irritating and promoting effect and thus promotes growth of fibrous fabric;

• Argosulfan can be applied also in dermatological practice. The way of treatment of some dermatosis by local putting medicaments with sulphathiazole became already classical (Ingels A.E., 1943);

• medicament can be used in surgical the LOR-expert. Its instillation in paranasal sinuses is possible (Berdal P., 1945) at surgical treatment of purulent sinusitis and also for sanitation of a wound in a mastoiditis (Berdal P., 1945);

• Argosulfan can be applied also to processing of small injuries of skin (a graze, a scratch) including at children. The last is especially convenient because putting medicament is not followed by burning (as at other antiseptic agents) and does not paint integuments and the adjoining clothes.

with

directly on a wound surface 2 or 3 times a day so that all wound was covered with a thin layer of cream. If the wound is infected, then at the initial stage of treatment the emergence of a large amount of exudate is possible. When bandagings it is necessary to delete at first exudate and the remains Argosulfan after the previous drawing. An optimal solution are 3% hydrogen peroxide solution as it is effective for mechanical clarification of a wound and have property to connect sulphathiazole molecules (Zhu G., 2019). As alternative means before putting cream it is recommended to apply 3% to bathing of the wound aqueous solution of boric acid or 0.1% aqueous solution of a chlorhexidin (instruction of MZ of Ukraine).

If need for washing arises it is long not healing wounds an antiseptic agent in intervals between drawing Argosulfan , then it is contraindicated to use methylene blue for these purposes. Such feature is connected with what methylene blue is an antagonist of sulphathiazole and at combined use these substances neutralize each other (Gots J.S., 1949). For the same reason you should not apply combined with medicament such local anesthetics as, for example, Procainum.

At selection of physiotherapeutic procedures for complex treatment of patients needs to be considered that the efficiency of sulphathiazole sharply decreases under the influence of electric current because of oxidative degradation of active ingredient (Baran W., 2018). Therefore Argosulfan cannot be combined with such procedures as an electrophoresis, diadynamotherapy (DDT), etc.

individually. Usually cream is applied before full healing of decubitus or until the wound surface is not prepared for transplantation of a skin rag. treats advantages Argosulfan also the fact that he does not paint integuments and other fabrics and allows to carry out an adequate visual estimate of their state.