Cochrane Database of Systematic Reviews Antiseptics for burns (Review) Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra DP, Hassan IA, Dumville JC Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra DP, Hassan IA, Dumville JC. Antiseptics for burns. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD011821. DOI: 10.1002/14651858.CD011821.pub2. www.cochranelibrary.com Antiseptics for burns (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 3 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 7 OBJECTIVES ..................................... 9 METHODS ...................................... 9 RESULTS....................................... 13 Figure1. ..................................... 14 Figure2. ..................................... 15 Figure3. ..................................... 17 Figure4. ..................................... 18 ADDITIONALSUMMARYOFFINDINGS . 33 DISCUSSION ..................................... 52 AUTHORS’CONCLUSIONS . 55 ACKNOWLEDGEMENTS . 56 REFERENCES ..................................... 56 CHARACTERISTICSOFSTUDIES . 64 DATAANDANALYSES. 161 Analysis 1.1. Comparison 1 Silver dressings versus topical antibiotics, Outcome 1 Wound healing (hazard ratio). 164 Analysis 1.2. Comparison 1 Silver dressings versus topical antibiotics, Outcome 2 Wound healing (mean time to healing). ................................... 165 Analysis 1.3. Comparison 1 Silver dressings versus topical antibiotics, Outcome 3 Wound healing (risk ratio) up to 28 days...................................... 166 Analysis 1.4. Comparison 1 Silver dressings versus topical antibiotics, Outcome 4 Infection (up to 4 weeks or NR). 167 Analysis 1.5. Comparison 1 Silver dressings versus topical antibiotics, Outcome 5 Adverse events (14-28 days). 168 Analysis 1.6. Comparison 1 Silver dressings versus topical antibiotics, Outcome 6 Withdrawals due to adverse events (21 daysorNR). .................................. 169 Analysis 1.7. Comparison 1 Silver dressings versus topical antibiotics, Outcome 7 Pain at dressing change (up to 28 days or NR)...................................... 169 Analysis 1.8. Comparison 1 Silver dressings versus topical antibiotics, Outcome 8 Pain (time/follow-up not specified). 170 Analysis 1.9. Comparison 1 Silver dressings versus topical antibiotics, Outcome 9 Mortality (21 days or NR). 171 Analysis 1.10. Comparison 1 Silver dressings versus topical antibiotics, Outcome 10 Resource use (number of dressings) (upto28daysorNR).. 172 Analysis 1.11. Comparison 1 Silver dressings versus topical antibiotics, Outcome 11 Costs (21 days or NR). 173 Analysis 1.12. Comparison 1 Silver dressings versus topical antibiotics, Outcome 12 Cost-effectiveness/wound healed (21 days). .................................... 174 Analysis 2.1. Comparison 2 Honey versus topical antibiotics, Outcome 1 Wound healing (hazard ratio). 174 Analysis 2.2. Comparison 2 Honey versus topical antibiotics, Outcome 2 Wound healing (risk ratio) (up to 60 days). 175 Analysis 2.3. Comparison 2 Honey versus topical antibiotics, Outcome 3 Wound healing (mean time to healing). 176 Analysis 2.4. Comparison 2 Honey versus topical antibiotics, Outcome 4 Incident infection (up to 24 days). 177 Analysis 2.5. Comparison 2 Honey versus topical antibiotics, Outcome 5 Persistent positive swabs (up to 21 days). 178 Analysis 2.6. Comparison 2 Honey versus topical antibiotics, Outcome 6 Adverse events (time points between 21 days and 6weeks). ................................... 179 Analysis 3.1. Comparison 3 Aloe vera vs topical antibiotics, Outcome 1 Wound healing (mean time to healing). 180 Analysis 3.2. Comparison 3 Aloe vera vs topical antibiotics, Outcome 2 Infection (time points between 14 days and 2 months). ................................... 181 Analysis 4.1. Comparison 4 Iodine-based treatments versus topical antibiotics, Outcome 1 Wound healing (mean time to healing). ................................... 182 Analysis 5.1. Comparison 5 Silver-based antiseptics versus non-antimicrobial, Outcome 1 Wound healing (mean time to healing). ................................... 182 Antiseptics for burns (Review) i Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 5.2. Comparison 5 Silver-based antiseptics versus non-antimicrobial, Outcome 2 Positive swab (21 days). 183 Analysis 6.1. Comparison 6 Honey versus non-antibacterial dressing, Outcome 1 Wound healing (hazard ratio). 184 Analysis 6.2. Comparison 6 Honey versus non-antibacterial dressing, Outcome 2 Wound healing (mean time to healing). ................................... 184 Analysis 6.3. Comparison 6 Honey versus non-antibacterial dressing, Outcome 3 Persistent positive swabs (up to 30 days). .................................... 185 Analysis 7.1. Comparison 7 Chlorhexadine versus non-antibacterial dressing, Outcome 1 Wound healing (mean time to healing). ................................... 186 Analysis 7.2. Comparison 7 Chlorhexadine versus non-antibacterial dressing, Outcome 2 Infection (up to 30 days). 187 Analysis 8.1. Comparison 8 Iodine-based antiseptics versus non-antibacterial treatments, Outcome 1 Wound healing (mean timetohealing).. ... ... ... ... ... ... ... ... ... ... .. 187 Analysis 8.2. Comparison 8 Iodine-based antiseptics versus non-antibacterial treatments, Outcome 2 Costs (duration 18 days+)..................................... 188 Analysis 9.1. Comparison 9 Cerium nitrate versus non antibacterial treatment, Outcome 1 Mortality (short-term or unclear). ................................... 189 ADDITIONALTABLES. 189 APPENDICES ..................................... 225 WHAT’SNEW..................................... 234 CONTRIBUTIONSOFAUTHORS . 234 DECLARATIONSOFINTEREST . 235 SOURCESOFSUPPORT . 235 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 236 INDEXTERMS .................................... 236 Antiseptics for burns (Review) ii Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Antiseptics for burns Gill Norman1, Janice Christie1, Zhenmi Liu1, Maggie J Westby1, Jayne M Jefferies2, Thomas Hudson2, Jacky Edwards3, Devi Prasad Mohapatra4, Ibrahim A Hassan5, Jo C Dumville1 1Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. 2Evidence Information Services, National Institute for Health and Care Excellence (NICE), Manchester, UK. 3Burn Centre, Acute Block, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK. 4Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. 5Microbiology, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK Contact address: Gill Norman, Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. [email protected]. Editorial group: Cochrane Wounds Group. Publication status and date: Edited (no change to conclusions), published in Issue 11, 2017. Citation: Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra DP, Hassan IA, Dumville JC. Antiseptics for burns. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD011821. DOI: 10.1002/14651858.CD011821.pub2. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after initial resuscitation) result from infection. Antiseptics are topical agents that act to prevent growth of micro-organisms. A wide range are used with the intention of preventing infection and promoting healing of burn wounds. Objectives To assess the effects and safety of antiseptics for the treatment of burns in any care setting. Search methods In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting. Selection criteria We included randomised controlled trials (RCTs) that enrolled people with any burn wound and assessed the use of a topical treatment with antiseptic properties. Data collection and analysis Two review authors independently performed study selection, risk of bias assessment and data extraction. Antiseptics for burns (Review) 1 Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results We included 56 RCTs with 5807 randomised participants. Almost all trials had poorly reported methodology, meaning that it is unclear whether they were at high risk of bias. In many cases the primary review outcomes, wound healing and infection,