Silver sulphadiazine (SSD) has been used in conservative management of partial thickness burns (PTB), for over 50 years. Concerns have been raised over potential disadvantages of SSD including need for daily dressing changes, impairment of wound healing and expense. The authors performed a systematic review of randomised controlled trials (RCTs) comparing SSD to alternative dressings (ADs) focusing on time to healing, infection, pain and patient satisfaction. ADs were divided into three groups – viscous (e.g. creams / gels / ointments), solid (e.g. plates / sheets) and biological (e.g. temporary skin replacements). Fifty-two studies met the inclusion criteria, comparing 30 ADs to SSD. Heterogeneity of study design prevented meta-analysis. Twenty- eight out of 46 studies found significantly improved time to healing with ADs. Eighteen studies showed no difference. Twenty-nine out of 40 studies demonstrated no significant difference in infection. One study demonstrated a statistically significant benefit of SSD, whilst five studies demonstrated benefit and five ‘trended towards significance’ for ADs. Twenty-two out of 34 studies reported less pain with ADs. Seven out of 21 studies favoured ADs with regard to patient satisfaction. No studies demonstrated a significant benefit of SSD with regard to pain, patient satisfaction, length of stay, scar quality or cost. The methodology appears sound, although only MEDLINE was searched, with no mention made of reference screening to identify relevant articles. As acknowledged by the authors, all burn depths were included in the study, not only PTB, partly due to limitations in RCTs which did not specify depth of burn or included all burns. The authors conclude no single AD can be recommended, however the majority of studies support the use of ADs to promote faster wound healing. They propose that the use of SSD can no longer be supported in healthcare environments with access to ADs. The authors suggest future studies should include laser doppler confirmed PTB, with intra- individual comparisons between different anatomical locations. This would provide homogenous data sets for meta-analysis and allow for comparison between individual ADs or to SSD.

The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review.
Heyneman A, Hoeksema H, Vandekerckhove D, et al.
Lewis Dingle

St John's Hospital, Livingston, UK.

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