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Abstract
When a tissue is injured, its vessels exhibit a marked increase in vascular permeability.
Blood proteins, including fibrinogen, traverse the vessel walls and lead to the development
of a surface coagulum. This inflammatory response continues until primary closure
of the wound edges is accomplished. The thickness of the surface coagulum is roughly
proportional to the time interval between wounding and closure. This coagulum encompasses
the surface contaminants, preventing contact with either topical or systemic antibiotics.
The presence of this surface coagulum limits the time in which antibiotic prophylaxis
is effective. At three hours after injury, antimicrobial prophylaxis of contaminated
wounds has no therapeutic value.
Hydrolysis of the protein coagulum by proteolytic enzymes enhances the activity of
the antibiotic in experimental wounds. The success of proteolytic enzymes as adjuncts
to delayed antibiotic treatment can be correlated with the clot lysis activity of
the enzymes in vitro. Travase, the most potent fibrinolytic enzyme, is the most effective
adjunct to delayed antibiotic therapy of contaminated wounds. In contrast, the active
enzymes found in Elase, which exhibit no significant clot lysis activity in vitro,
do not potentiate the activity of antibiotics in wounds subjected to a delay in treatment.
Travase prolongs the period of effective topical antibiotic action for at least eight
hours in experimental contaminated wounds. The therapeutic merit of Travase is also
apparent when the antibiotic is administered systemically. Travase shows promise as
an adjunct to a variety of antibiotics that are effective against both gram-positive
and gram-negative organisms.
The results of these experimental studies support our belief that clinical studies
should now be initiated to test the therapeutic value of Travase as an adjunct to
antibiotics in heavily contaminated wounds subjected to an unavoidable delay in treatment.
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References
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© 1975 Published by Elsevier Inc.
