Wednesday, August 14, 2013

Antibiotics to Prevent Burn Infection - Systematic Review

This is very interesting... For years I was taught, to smear the "white cool mayo" on burns to prevent infection. Now, I am not so sure I should continue doing that. Maybe applying Vaseline gauze is better (and cheaper) to protect the wound and with less risk of infection compared with the expensive "Silvadene". The same may apply systemic abxs. I guess everything goes back to the basics of good wound care.;jsessionid=29FCB5487AAB811548AF3EDF1CF2E681.d03t02

Here are the critical findings

There was a statistically significant increase in burn wound infection associated with silver sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to 3.19, I2 = 0%). These trials were at high, or unclear, risk of bias. Silver sulfadiazine was also associated with significantly longer length of hospital stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to 2.28).

- Systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia (only one trial, 40 participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59 participants) (RR = 0.43; 95% CI: 0.12 to 1.61).

- Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of this review.

- Selective decontamination of the digestive tract with non-absorbable antibiotics had no significant effect on rates of all types of infection (2 trials, 140 participants). Moreover, there was a statistically significant increase in rates of MRSA associated with use of non-absorbable antibiotics plus cefotaxime compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).

- There was no evidence of a difference in mortality or rates of sepsis with local airway antibiotic prophylaxis compared with placebo (only one trial, 30 participants).

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