Antibacterial effect of phenytoin in wound healing

Abstract number: 1134_02_279

Abolghasemi S., Mostanfar B.

Objectives:

Phenytoin is an antiseizure medication, has since been reported to promote wound healing when applied as a topical agent. This effect is due to rapid infiltration of fibroblasts, collagen deposition, new vessel formation as well as antibacterial activity. This study was undertaken to evaluate it's effect on chronic skin ulcers with different causes and compare it with normal saline.

Methods:

Fifty inpatients with chronic skin ulcers were included in this case-control study: diabetic foot (20%), fracture and surgery wounds (40%), decubitus ulcers resulting from war-related (40%). The patients were matched for age, sex, severity and size of wounds and randomly assigned to two group: 25 phenytoin treated (pht) and 25 control (ctl). Each group included 15 men and 10 women, age range was between 20 and 60. Surface areas of the ulcers was 12–200 cm².

The ulcers were debraded of necrotic tissue (if required). Cultures of ulcers were taken at the beginning of treatment and on day 7, 14. In pht, thin dusting of phenytoin powder and dry gauze dressing were applied daily after washing with normal saline. Ctl group received only daily washing with normal saline and plain dressing.

Results:

Bacteriologic culture in both group confirmed some strains (Staphylococcus aureus, Kelebsiella, Proteus and Psudomonas). At the beginning of treatment, there was 17 culture positive in pht. 13 case became negative by day 7 and 4 case became negative by day 14. In ctl, we had 15 culture positive that they didn't become negative by day 7 and 14 (seventy-six per cent of pht had negative cultures by day 7 compared to 0% of ctl). The mean time for appearance of granulation tissue was 13.48 days in pht compared with ctl that was 37.5 (p = 0.006). The average time to complete healing in pht was 24.76 days compared to 43.36 in the ctl (p = 0.0001). In pht only 13 patients required to analgesics (mean 1/day) compared with ctl that all patients required to analgesics about 3–4/day (p = 0.0001). Age, sex and kind of wounds didn't effect the healing time in both group.

Conclusions:

This study with statistical analysis demonstrated good improvement and efficacy of phenytoin in treatment of chronic ulcers compared with normal saline.

1. prompt pain relief, 2. reduction in ulcer size, 3. changing bacterial culture to negative, 4. more rapid granulation and healing time, characterized the pht group.

We recommend wider use of this safe, inexpensive, readily available and easy to use agent because of it's positive effect on wound healing especially in our country that a lot of patients suffer from decubitus ulcers resulting from war-related wounds and limited access to more expensive wound care therapies.