I have noticed increased popularity in the use of silver sulfadiazine cream (Silvadene) for a variety of wounds, including pressure sores and similar wounds, but not third-degree burns. The results are usually dramatic. Should Silvadene cream be the first choice for such wounds? Is there supportive literature?—FERNANDO HERNANDEZ, MD, Chicago

Is the use of phenytoin powder (Dilantin tablets crushed and applied b.i.d.) acceptable for poorly healing decubitus or pressure ulcers? I have used it successfully on several patients.—BERND RAPHAEL, MD, Lehigh Acres, Fla.

Silver sulfadiazine is certainly a frequent choice for wounds and burns. A survey of the literature indicates that some other topical antibiotics may be equally or more effective, including iodophors and Neosporin (bacitracin, neomycin, polymixin B). Therefore, silver sulfadiazine is certainly an option, but not the obligatory first-line agent. Topical phenytoin has been used successfully in the healing of pressure sores, venous stasis and diabetic ulcers, traumatic wounds, and burns. Oral phenytoin therapy is used widely for the treatment of convulsive disorders. About half the patients treated develop gingival overgrowth as a side effect. This apparent stimulatory effect prompted its assessment in wound healing.—Jeffrey M. Weinberg, MD (147-10)