Proteolytic enzymes as adjuncts to antibiotic prophylaxis of surgical wounds

Abstract

The success of antibiotic treatment of contaminated open wounds is related to the time at which the antibiotic is administered. In standardized guinea pig wounds contaminated with 10 6 S aureus, immediate treatment with topical benzyl penicillin prevents the development of infection. When this same treatment is delayed three hours, all wounds become infected. It is our belief that the fibrinous exudate present in open wounds prevents the antibiotic from gaining access to the sites of bacterial contamination and limits the therapeutic benefits of delayed antibiotic therapy. Enzymatic hydrolysis of the wound coagulum with the proteolytic enzyme trypsin significantly enhances the therapeutic value of antibiotics in the delayed treatment of contaminated wounds. On the basis of these experimental studies, a regimen has been established for the use of proteolytic enzymes as an adjunct to delayed antibiotic treatment of contaminated wounds. When treatment is delayed three hours, the optimal dose of trypsin is 25,000 NF units per wound. The effectiveness of trypsin is enhanced by prolonging its application time; contact of the enzyme with the wound for thirty minutes prevents the development of infection and limits bacterial growth. The effectiveness of the enzyme is increased by repeating the applications. The route by which the antibiotic is administered does not affect the value of proteolytic enzymes; proteolytic enzymes enhance the therapeutic value of both topical and systemic antibiotics.