A.K. Srivastava, M.B.,B.S.,
A.D.M.O, L.N.M.N.E., Railway Hospital, Gorakpur.

Ulcers and wounds are world-wide problems with which patients on varying age and sex attend the O.P.D. of every hospital and clinic. Treatment of any ulcer, acute or chronic, depends on finding the cause and dealing with it. Local treatment includes dressing, coping with infection, discharge and sloughs and measures to aid or speed healing such as rest in bed, splint application and supportive bandages.

Antibiotics are commonly used to treat these conditions. However, if one type of organism is cleared from an ulcer area, another type will replace it and thus resistance develops to antibiotics. To prevent the growth of organisms we use an antiseptic and disinfectant over the ulcers and wounds. But when used in high concentrations to destroy the micro-organisms it is seen in most cases that some destruction of tissues in unavoidable.

Antibiotics are of little value in clearing the infection on the surface of ulcers and wounds when they are used topically. Thus their systemic use assumes greater importance. Most of the antibiotics have toxic effects like gastrointestinal irritation, superinfection, hypersensitivity, other allergic reactions etc.

A few points to be borne in mind in choosing the right antibiotic for treatment of ulcers and wounds are as follows:

The antibacterial, anti-inflammatory and anti-exudative properties of Septilin (Himalaya) attracted us to use it in the treatment of ulcers and wounds. Balsamodendron mukul (Guggul) is reputed to be an ancient `broad spectrum' drug with a wide therapeutic range. It raises the general defence mechanism of the body and thus helps overcome infective and inflammatory processes. It not only builds up resistance to disease but has the capacity to neutralise the causative factor. As an alternative, it is capable of normalising the deranged cellular metabolism.

Septilin is vastly used by many clinicians in chronic stubborn infections as it is effective against gram +ve and gram —ve bacteria and spirochetes and also against certain fungi. Besides, it has been noted that Septilin improves phagocytosis and the phagocytic co-efficient, thus helping to eradicate and prevent infections.

One hundred and fifty cases in the O.P.D. of the L.N.M.N.E. Railway Hospital, Gorakhpur were selected and treated. Of these only 123 cases came for follow-up. Septilin tablets were supplied by The Himalaya Drug Co. The other antibiotics used were inj. Procaine pencillin, inj. Streptopencillin, a combination of trimethoprim and sulphamethoxazole, ampicillin, demeclocycline, tetracycline etc.

The drug was tried on various specific and non-specific wounds including fresh wounds but not malignant ulcers. The details are shown in Tables 1 and 2.

One hundred cases were taken up with fresh and infected wounds, of which 40 cases were treated with Septilin alone, 30 with antibiotics alone and the remaining 30 with Septilin + antibiotics combined.

The wounds were on the hand, lower legs, trunk and the back. They were from 2.5 cm to 10 cm in diameter. The wounds were incised or lacerated in nature. Inguinal and axillary lymph nodes were inflammed in infective wounds and the patients were febrile. The margins of the wounds were inflamed with profuse discharge from the ulcer and the floor was covered with slough.

In fresh wounds Septilin was used prophylactically to prevent the ulcers from turning infectious. Septillin is found equally effective in comparision to other antibiotics; hence Septilin should be used as the drug of choice in sterile dressings in place of an antibiotic.

Forty-five infected wounds were also treated, of which 15 were treated with Septilin alone (Table 2). In 3 cases cellulitis developed in which pus was drained out by incision and drainage. Septilin was given for 10 to 14 days in the dosage of 2 tabs., t.i.d. with antiseptic dressing. The patients were afebrile within 24 hours and the size of the lymph nodes and tenderness decreased after 72 hours. The glands disappeared after treatment lasting two weeks. The oozing from the ulcer surface decreased within 48 hours and epithelium grew from the margins. Red granulation tissues appeared after a week's treatment with Septilin and finally the patients were cured within 2 weeks. Complicated non-specific ulcers like varicose ulcers, bed sores and perforated ulcers not included in this study although four, know cases of diabetes were also treated with Septilin alone and cured.

Next, 23 chronic, non-specific wounds like sinuses and fistulae, osteomyelitis of small bones and superficial burns were studied, with Septilin alone. Details are shown in Table 3.

As seen in Table 1, 25 cases treated with fresh cuts caused within a short duration of 2 hours, were healed in the same time as taken by other antibiotics (5 days). Moreover, when Septilin was used as an adjuvant to antibiotics the healing period was reduced by two days (from 5 to 3 days).

Similarly, in 15 cases of infected wounds, treated with Septilin alone, 2 tabs. t.i.d. for 10 to 14 days, it was observed that the oozing from the surface of the ulcers was reduced within 72 hours. The lymph nodes involved also reduced in size and epithelium grew quickly from the adjacent area of the ulcers after a week's treatment. Finally the ulcers healed up in 10-14 days' time. Remarkably it was observed that the duration of treatment is shortened to 7-10 days in 15 such similar number of cases, when Septilin was used along with antibiotics (See Table 2).

Three cases of osteomyelitis of the proximal phalanges, which were crushed by a blunt object and later on became infected, were treated with Septilin alone and were cured after about 45 days (See Table 3).

Ten cases of sinuses and fistulae, situated in the region of the anus, were also treated. Earlier they were treated with other antibiotics and cured but recurrence was seen in all of them. 6 of them healed up completely with Septilin, 2 tabs. t.i.d. for 30 to 45 days. However, 4 of them were referred for surgical treatment as they did not respond to Septilin.

There were 10 patients with superficial burns over the hands and legs, which later on became infected after 10 days. They were treated with Septilin alone for 2 weeks and cured completely.

I am very thankful to The Himalaya Drug Co. for the supply of Septilin tablets used in this study.

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