Antiseptics for burns

Gill Norman, Janice Christie, Zhenmi Liu, Maggie J Westby, Jayne M Jefferies, Thomas Hudson, Jacky Edwards, Devi Prasad Mohapatra, Ibrahim A Hassan, Jo C Dumville, Gill Norman, Janice Christie, Zhenmi Liu, Maggie J Westby, Jayne M Jefferies, Thomas Hudson, Jacky Edwards, Devi Prasad Mohapatra, Ibrahim A Hassan, Jo C Dumville

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.

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, were not reported, or were reported incompletely.Most trials enrolled people with recent burns, described as second-degree and less than 40% of total body surface area; most participants were adults. Antiseptic agents assessed were: silver-based, honey, Aloe Vera, iodine-based, chlorhexidine or polyhexanide (biguanides), sodium hypochlorite, merbromin, ethacridine lactate, cerium nitrate and Arnebia euchroma. Most studies compared antiseptic with a topical antibiotic, primarily silver sulfadiazine (SSD); others compared antiseptic with a non-antibacterial treatment or another antiseptic. Most evidence was assessed as low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, often in single studies. Antiseptics versus topical antibioticsCompared with the topical antibiotic, SSD, there is low certainty evidence that, on average, there is no clear difference in the hazard of healing (chance of healing over time), between silver-based antiseptics and SSD (HR 1.25, 95% CI 0.94 to 1.67; I2 = 0%; 3 studies; 259 participants); silver-based antiseptics may, on average, increase the number of healing events over 21 or 28 days' follow-up (RR 1.17 95% CI 1.00 to 1.37; I2 = 45%; 5 studies; 408 participants) and may, on average, reduce mean time to healing (difference in means -3.33 days; 95% CI -4.96 to -1.70; I2 = 87%; 10 studies; 979 participants).There is moderate certainty evidence that, on average, burns treated with honey are probably more likely to heal over time compared with topical antibiotics (HR 2.45, 95% CI 1.71 to 3.52; I2 = 66%; 5 studies; 140 participants).There is low certainty evidence from single trials that sodium hypochlorite may, on average, slightly reduce mean time to healing compared with SSD (difference in means -2.10 days, 95% CI -3.87 to -0.33, 10 participants (20 burns)) as may merbromin compared with zinc sulfadiazine (difference in means -3.48 days, 95% CI -6.85 to -0.11, 50 relevant participants). Other comparisons with low or very low certainty evidence did not find clear differences between groups.Most comparisons did not report data on infection. Based on the available data we cannot be certain if antiseptic treatments increase or reduce the risk of infection compared with topical antibiotics (very low certainty evidence). Antiseptics versus alternative antisepticsThere may be some reduction in mean time to healing for wounds treated with povidone iodine compared with chlorhexidine (MD -2.21 days, 95% CI 0.34 to 4.08). Other evidence showed no clear differences and is of low or very low certainty. Antiseptics versus non-antibacterial comparatorsWe found high certainty evidence that treating burns with honey, on average, reduced mean times to healing in comparison with non-antibacterial treatments (difference in means -5.3 days, 95% CI -6.30 to -4.34; I2 = 71%; 4 studies; 1156 participants) but this comparison included some unconventional treatments such as amniotic membrane and potato peel. There is moderate certainty evidence that honey probably also increases the likelihood of wounds healing over time compared to unconventional anti-bacterial treatments (HR 2.86, 95% C 1.60 to 5.11; I2 = 50%; 2 studies; 154 participants).There is moderate certainty evidence that, on average, burns treated with nanocrystalline silver dressings probably have a slightly shorter mean time to healing than those treated with Vaseline gauze (difference in means -3.49 days, 95% CI -4.46 to -2.52; I2 = 0%; 2 studies, 204 participants), but low certainty evidence that there may be little or no difference in numbers of healing events at 14 days between burns treated with silver xenograft or paraffin gauze (RR 1.13, 95% CI 0.59 to 2.16 1 study; 32 participants). Other comparisons represented low or very low certainty evidence.It is uncertain whether infection rates in burns treated with either silver-based antiseptics or honey differ compared with non-antimicrobial treatments (very low certainty evidence). There is probably no difference in infection rates between an iodine-based treatment compared with moist exposed burn ointment (moderate certainty evidence). It is also uncertain whether infection rates differ for SSD plus cerium nitrate, compared with SSD alone (low certainty evidence).Mortality was low where reported. Most comparisons provided low certainty evidence that there may be little or no difference between many treatments. There may be fewer deaths in groups treated with cerium nitrate plus SSD compared with SSD alone (RR 0.22, 95% CI 0.05 to 0.99; I2 = 0%, 2 studies, 214 participants) (low certainty evidence).

Authors' conclusions: It was often uncertain whether antiseptics were associated with any difference in healing, infections, or other outcomes. Where there is moderate or high certainty evidence, decision makers need to consider the applicability of the evidence from the comparison to their patients. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.

Conflict of interest statement

Gill Norman: my employment at the University of Manchester is funded by the National Institute for Health Research (NIHR) UK and focuses on high priority Cochrane Reviews in the prevention and treatment of wounds.

Janice Christie: none known.

Zhenmi Lui: my employment at the University of Manchester is funded by the NIHR (NIHR Research Methods Programme Systematic Review Fellowship NIHR‐RMFI‐2015‐06‐52).

Maggie Westby: My employment at the University of Manchester is funded by the NIHR and focuses on high priority Cochrane Reviews in the prevention and treatment of wounds.

Jayne Jeffries: none known.

Thomas Hudson: none known.

Jacky Edwards: none known.

Devi Prasad Mohapatra: none known.

Ibrahim Hassan: none known.

Jo Dumville: I receive research funding from the NIHR for the production of systematic reviews focusing on high priority Cochrane Reviews in the prevention and treatment of wounds. This work was also partly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester.

Andrew Jull (peer reviewer) is the author of a published Cochrane Review investigating the effect of honey on wounds Jull 2015, which was the source of some of the raw data for this review.

Figures

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PRISMA flow diagram
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Network of included treatment types
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

References

References to studies included in this review Abedini 2013 {published data only}

    1. Abedini F, Ahmadi A, Yavari A, Hosseini V, Mousavi S. Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy. International Wound Journal 2013;10(5):573‐8.
Adhya 2015 {published data only}
    1. Adhya A, Bain J, Ray O, Hazra A, Adhikari S, Dutta G, et al. Healing of burn wounds by topical treatment: a randomized controlled comparison between silver sulfadiazine and nano‐crystalline silver. Journal of Basic and Clinical Pharmacy 2015;6(1):29‐34.
Akhtar 1996 {published data only}
    1. Akhtar MA, Hatwar SK. Efficacy of Aloe vera extract cream in management of burn wound. Journal of Clinical Epidemiology 1996;49(Supp 1):24.
Baghel 2009 {published data only}
    1. Baghel PS, Shukla S, Mathur RK, Randa R. A comparative study to evaluate the effect of honey dressing and silver sulfadiazine dressing on wound healing in burn patients. Indian Journal of Plastic Surgery 2009;42(2):176‐81.
Bangroo 2005 {published data only}
    1. Bangroo AK, Katri R, Chauhan S. Honey dressing in pediatric burns. Journal of the Indian Association of Plastic Surgeons 2005;10(3):172‐5.
Carayanni 2011 {published data only}
    1. Carayanni VJ, Tsati EG, Spyropoulou GC, Antonopoulou FN, Ioannovich JD. Comparing oil based ointment versus standard practice for the treatment of moderate burns in Greece: a trial based cost effectiveness evaluation. BMC Complementary and Alternative Medicine 2011;11:122.
Caruso 2006 {published data only}
    1. Caruso DM, Foster KN, Blome‐Eberwein SA, Twomey JA, Herndon DN, Luterman A, et al. Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial‐thickness burns. Journal of Burn Care and Research 2006;27(3):298‐309.
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Chen 2006 {published data only}
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De Gracia 2001 {published data only}
    1. Gracia CG. An open study comparing topical silver sulfadiazine and topical silver sulfadiazine‐cerium nitrate in the treatment of moderate and severe burns. Burns 2001;27(1):67‐74. [DOI: ]
Glat 2009 {published data only}
    1. Glat PM, Kubat WD, Hsu JF, Copty T, Burkey BA, Davis W, et al. Randomized clinical study of SilvaSorb gel in comparison to Silvadene silver sulfadiazine cream in the management of partial‐thickness burns. Journal of Burn Care and Research 2009;30(2):262‐7.
Gong 2009 {published data only}
    1. Gong Z‐H, Yao J, Ji J‐F, Yang J, Xiang T. Effect of ionic silver dressing combined with hydrogel on degree II burn wound healing. Journal of Clinical Rehabilitative Tissue Engineering 2009;13(42):8373‐6.
Han 1989 {published data only}
    1. Han KH, Maitra AK. Management of partial skin thickness burn wounds with Inadine dressings. Burns 1989;15(6):399‐402.
Healy 1989 {published data only}
    1. Healy CM, Boorman JG. Comparison of E‐Z Derm and Jelonet dressings for partial skin thickness burns. Burns 1989;15(1):52‐4.
Homann 2007 {published data only}
    1. Homann H‐H, Rosbach O, Moll W, Vogt PM, Germann G, Hopp M, et al. A liposome hydrogel with polyvinyl‐pyrrolidone iodine in the local treatment of partial‐thickness burn wounds. Annals of Plastic Surgery 2007;59(4):423‐7.
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Huang 2007 {published data only}
    1. Huang Y, Li X, Liao Z, Zhang G, Liu Q, Tang J, et al. A randomized comparative trial between Acticoat and SD‐Ag in the treatment of residual burn wounds, including safety analysis. Burns 2007;33(2):161‐6.
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Inman 1984 {published data only}
    1. Inman RJ, Snelling CF, Roberts FJ, Shaw K, Boyle JC. Prospective comparison of silver sulfadiazine 1 per cent plus chlorhexidine digluconate 0.2 per cent (Silvazine) and silver sulfadiazine 1 per cent (Flamazine) as prophylaxis against burn wound infection. Burns 1984;11(1):35‐40.
    1. Snelling CF, Inman RJ, Germann E, Boyle JC, Foley B, Kester DA, et al. Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns. Journal of Burn Care and Rehabilitation 1991;12(1):13‐8.
Jiao 2015 {published data only}
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Khorasani 2009 {published data only}
    1. Khorasani G, Hosseinimehr SJ, Azadbakht M, Zamani A, Mahdavi MR. Aloe versus silver sulfadiazine creams for second‐degree burns: a randomised controlled study. Surgery Today 2009;39(7):587‐91.
Li 1994 {published data only}
    1. Li Y, Wang N, Zhou C. A comparison between 'moist ointment' and 0.25% iodophor, silver sulfadiazine paste and 0.1% Rivanol in the treatment of deep II degree burn wounds. Chinese Journal of Plastic Surgery and Burns 1994;10(5):342‐5.
Li 2006 {published data only}
    1. Li LG, Chai JK, Guo ZR, Yang HM, Jia XM, Xu MH, et al. Application of carbon fiber dressing on burn wounds. Zhonhghua shao shang za zhi [Chinese Journal of Burns] 2006;44(15):1047‐9.
Liao 2006 {published data only}
    1. Liao ZJ, Huan JN, Lv GZ, Shou YM, Wang ZY. Multi‐center clinical study of the effect of silver nitrate ointment on the partial‐thickness burn wounds. Zhonghua wai ke za zhi [Chinese Journal of Surgery] 2006;22(5):359‐61.
Maghsoudi 2011 {published data only}
    1. Maghsoudi H, Salehi F, Khosrowshahi MK, Baghaei M, Nasirzadeh M, Shams R. Comparison between topical honey and mafenide acetate in treatment of burn wounds. Annals of Burns and Fire Disasters 2011;24(3):132‐7.
Malik 2010 {published data only}
    1. Malik KI, Malik MA, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial‐thickness burns. International Wound Journal 2010;7(5):413‐7.
Mashhood 2006 {published data only}
    1. Mashhood AA, Khan TA, Sami AN. Honey compared with 1% silver sulfadiazine cream in the treatment of superficial and partial thickness burns. Journal of the Pakistan Association of Dermatologists 2006;16(1):14‐9.
Memon 2005 {published data only}
    1. Memon AR, Tahir SM, Khushk, Memon GA. Therapeutic effects of honey versus silver sulphadiazine in the management of burn injuries. Journal of Liaquat University of Medical and Health Sciences 2005;4(3):100‐4.
Muangman 2006 {published data only}
    1. Muangman P, Chuntrasakul C, Silthram S, Suvanchote S, Benjathanung R, Kittidacha S, et al. Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial‐thickness burn wounds. Chotmaihet thangphaet [Journal of the Medical Association of Thailand] 2006;89(7):953‐8.
Muangman 2010 {published data only}
    1. Muangman P, Pundee C, Opasanon S, Muangman S. A prospective, randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns. International Wound Journal 2010;7(4):271‐6.
Nasiri 2016 {published data only}
    1. Nasiri E, Hosseinimehr SJ, Zaghi Hosseinzadeh A, Azadbakht M, Akbari J, Azadbakht M. The effects of Arnebia euchroma ointment on second‐degree burn wounds: a randomized clinical trial. Journal of Ethnopharmacology 2016;189:107‐16.
Neal 1981 {published data only}
    1. Neal DE, Whalley PC, Flowers MW, Wilson DH. The effects of an adherent polyurethane film and conventional absorbent dressing in patients with small partial thickness burns. British Journal of Clinical Practice 1981;35(7‐8):254‐7.
Ning 2008 {published data only}
    1. Ning F‐G, Zhang G‐A. Efficacy of dermacyn on deep partial second‐degree burns. Chinese Journal of New Drugs 2008;17(8):691‐2.
Oen 2012 {published data only}
    1. Oen IM, Baar ME, Middelkoop E, Nieuwenhuis MK, Facial Burns Group. Effectiveness of cerium nitrate‐silver sulfadiazine in the treatment of facial burns: a multicenter, randomized, controlled trial. Plastic and Reconstructive Surgery 2012;130(2):274e‐83e.
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Opasanon 2010 {published data only}
    1. Opasanon S, Muangman P, Namviriyachote N. Clinical effectiveness of alginate silver dressing in outpatient management of partial‐thickness burns. International Wounds Journal 2010;7(6):467‐71.
    1. Opasanon S, Muangman P, Namviriyachote N, Chuntrasakul C. Clinical effectiveness of alginate silver dressing in outpatient management of partial‐thickness burns. EWMA Journal 2010;10(2):148.
Panahi 2012 {published data only}
    1. Moharamzad Y, Panahi Y, Beiraghdar F, Feizi I. Clinical efficacy of a topical herbal cream (Aloe vera, Geranium robertianum and Lavandula stoechas) in second‐degree burn wounds. Basic & Clinical Pharmacology & Toxicolocy 2010;107(Supp 1):466.
    1. Panahi Y, Beiraghdar F, Akbari H, Bekhradi H, Taghizadeh M, Sahebkar A. A herbal cream consisting of Aloe vera, Lavandula stoechas, and Pelargonium roseum as an alternative for silver sulfadiazine in burn management. Asian Biomedicine 2012;6(2):273‐8.
Phipps 1988 {published data only}
    1. Phipps A, Lawrence JB. Comparison of hydrocolloid dressings and medicated tulle‐gras in the treatment of outpatient burns. Beyond Occlusion: Wound Care Proceedings, Royal Society of Medicine Services International Congress and Symposium 1988;136:121‐5.
Piatkowski 2011 {published data only}
    1. Piatkowski A, Drummer N, Andriessen A, Ulrich D, Pallua N. RCT comparing a polihexanide containing bio‐cellulose dressing with silver sulfadiazine cream in partial thickness dermal burns. EWMA Journal 2011;2(Supp):63.
    1. Piatkowski A, Drummer N, Andriessen A, Ulrich D, Pallua N. Randomized controlled single center study comparing a polyhexanide containing bio‐cellulose dressing with silver sulfadiazine cream in partial‐thickness dermal burns. Burns 2011;37(5):799‐803.
Piccolo‐Daher 1990 {published data only}
    1. Piccolo‐Daher MT, Piccolo‐Lobo MS, Piccolo NS, Piccolo N. Efficacy of five topical agents in burn treatment: a comparative study [Estudo comparativo da eficacia de cinco medicamentos topicos no tratamento de queimaduros]. Revista Goiana de Medicina 1990;36(1):55‐9.
Radu 2011 {published data only}
    1. Radu CA, Gazyakan E, Germann G, Riedel K, Reichenberger M, Ryssel H. Optimizing Suprathel®‐therapy by the use of Octenidine‐Gel®. Burns 2011;37(2):294‐8.
Sami 2011 {published data only}
    1. Sami AM, Qureshi N, Zeeshan M, HIrfan A, Khan M. Honey compared with silver sulfadiazine as burn wound dressing. Annals of the Pakistan Institute of Medical Science 2011;7(1):22‐5.
Shahzad 2013 {published data only}
    1. Shahzad MN, Ahmed N. Effectiveness of Aloe vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns. Journal of the Pakistan Medical Association 2013;63(2):225‐30.
Silverstein 2011 {published data only}
    1. Silverstein P, Heimbach D, Meites H, Latenser B, Mozingo D, Mullins F, et al. An open, parallel, randomized, comparative, multicenter study to evaluate the cost‐effectiveness, performance, tolerance, and safety of a silver‐containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream. Journal of Burn Care and Research 2011;32(6):617‐26.
    1. Silverstein P, Heimbach D, Meites H, Latenser B, Mozingo D, Mullins F, et al. Soft silicone dressing with silver versus silver sulfadiazine cream in the treatment of partial‐thickness burns: a randomised controlled trial. EWMA Journal 2010;10(2):149.
Subrahmanyam 1991 {published data only}
    1. Subrahmanyam M. Topical application of honey in treatment of burns. British Journal of Surgery 1991;78(4):497‐8.
Subrahmanyam 1993b {published data only}
    1. Subrahmanyam M. Honey impregnated gauze versus polyurethane film (OpSite (R)) in the treatment of burns ‐ a prospective randomised study. British Journal of Plastic Surgery 1993;46(4):322‐3.
Subrahmanyam 1994 {published data only}
    1. Subrahmanyam M. Honey‐impregnated gauze versus amniotic membrane in the treatment of burns. Burns 1994;20(4):331‐3.
Subrahmanyam 1996a {published data only}
    1. Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns 1996;22(6):491‐3.
Subrahmanyam 1996b {published data only}
    1. Subrahmanyam M. Addition of antioxidants and polyethylene glycol 4000 enhances the healing property of honey in burns. Annals of Burns and Fire Disasters 1996;9(2):93‐5.
Subrahmanyam 1998 {published data only}
    1. Subrahmanyam M. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 1998;24(2):157‐61.
Subrahmanyam 2001 {published data only}
    1. Subrahmanyam M, Sahapure AG, Nagane NS, Bhagwat VR, Ganu JV. Effects of topical application of honey on burn wound healing. Annals of Burns and Fire Disasters 2001;14(3):143‐5.
Tang 2015 {published data only}
    1. Tang H, Lv G, Fu J, Niu X, Li Y, Zhang M, et al. An open, parallel, randomized, comparative, multicenter investigation evaluating the efficacy and tolerability of Mepilex Ag versus silver sulfadiazine in the treatment of deep partial‐thickness burn injuries. Journal of Trauma and Acute Care Surgery 2015;78(5):1000‐7.
Thamlikitkul 1991 {published data only}
    1. Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W, Theerapong S, Chantrakul C, Thanaveerasuwan T, et al. Clinical trial of Aloe vera Linn. for treatment of minor burns. Siriraj Hospital Gazette 1991;43(5):31‐6.
Thomas 1995 {published data only}
    1. Thomas SS, Lawrence JC, Thomas A. Evaluation of hydrocolloids and topical medication in minor burns. Journal of Wound Care 1995;4(5):218‐20.
Varas 2005 {published data only}
    1. Varas RP, O'Keeffe T, Namias N, Pizano LR, Quintana OD, Herrero Tellachea M, et al. A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial‐thickness burns: which method is less painful?. Journal of Burn Care and Rehabilitation 2005;26(4):344‐7.
Wright 1993 {published data only}
    1. Wright A, MacKechnie DW, Paskins JR. Management of partial thickness burns with Granuflex 'E' dressings. Granuflex 'E' vs Bactigras. Burns 1993;19(2):128‐30.
Yang 2013 {published data only}
    1. Yang H‐Z, Wang W‐K, Yuan L‐L, Wang S‐B, Luo G‐X, Wu J, et al. Multi‐center clinical trial of FLAMIGEL (hydrogel dressing) for the treatment of residual burn wound. Zhonhghua shao shang za zhi [Chinese Journal of Burns] 2013;29(2):177‐80.
Yarboro 2013 {published data only}
    1. Yarboro DD. A comparative study of the dressings silver sulfadiazine and Aquacel Ag in the management of superficial partial‐thickness burns. Advances in Skin and Wound Care 2013;26(6):259‐62 (20 ref).
Zahmatkesh 2015 {published data only}
    1. Zahmatkesh M, Manesh MJ, Babashahabi R. Effect of olea ointment and acetate mafenide on burn wounds: randomized clinical trial. Iranian Journal of Nursing and Midwifery Research 2015;20(5):599‐603.
Zhou 2011 {published data only}
    1. Zhou P‐Y, Xia Z‐F, Ben D‐F, Ma B, Fang H, Feng P. Clinical application of Aquacel‐Ag dressing in treatment of pediatric superficial I burn wounds. Academic Journal of Second Military Medical University 2011;32(12):1321‐3.
References to studies excluded from this review Afilalo 1992 {published data only}
    1. Afilalo M, Dankoff J, Guttman A, Lloyd J. DuoDERM hydroactive dressing vs silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns. Burns 1992;18(4):313‐6.
Ang 2002 {published data only}
    1. Ang ES, Lee ST, Gan CS, See P, Chan YH, Ng LH, et al. The role of alternative therapy in the management of partial thickness burns of the face: experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine. Annals of the Academy of Medicine 2002;29(1):7‐10.
    1. Ang ES, Lee ST, Gan CS, See PG, Chan YH, Ng LH, et al. Evaluating the role of alternative therapy in burn wound management: randomized trial comparing moist exposed burn ointment with conventional methods in the management of patients with second‐degree burns. Medscape General Medicine 2001;3(2):3.
Ang 2003 {published data only}
    1. Ang E, Lee S‐T, Gan CS‐G, Chan Y‐H, Cheung Y‐B, Machin D. Pain control in a randomized, controlled, clinical trial comparing moist exposed burn ointment and conventional methods in patients with partial‐thickness burns. Journal of Burn Care and Rehabilitation 2003;24(5):289‐96.
Babb 1977 {published data only}
    1. Babb JR, Bridges K, Jackson DM, Lowbury EJ, Ricketts CR. Topical chemoprophylaxis: trials in silver phosphate chlorhexidine, silver sulphadiazine and povidone iodine preparations. Burns 1977;3(2):65‐71.
Bowser 1981 {published data only}
    1. Bowser BH, Caldwell FT, Cone JB, Eisenach KD, Thompson CH. A prospective analysis of silver sulfadiazine with and without cerium nitrate as a topical agent in the treatment of severely burned children. Journal of Trauma 1981;21(7):558‐63.
Brown 2016 {published data only}
    1. Brown M, Dalziel SR, Herd E, Johnson K, Wong SR, Shepherd M. A randomized controlled study of silver‐based burns dressing in a pediatric emergency department. Journal of Burn Care and Research 2016;37(4):e340‐e347.
Cason 1966 {published data only}
    1. Cason JS, Jackson DM, Lowbury EJ, Ricketts CR. Antiseptic and aseptic prophylaxis for burns: use of silver nitrate and of isolators. British Medical Journal 1966;2(5525):1288‐94.
Chen 2007 {published data only}
    1. Chen J, Han C‐M, Su G‐L, Tang Z‐J, Su S‐J, Lin X‐W. Randomized controlled trial of the absorbency of four dressings and their effects on the evaporation of burn wounds. Chinese Medical Journal 2007;120(20):1788‐91.
Chmyrev 2011 {published data only}
    1. Chmyrev I. Use of silver containing wound dressings after late necrectomy in the patients with deep burns. EWMA Journal 2011;11(Supp 2):114.
Chokotho 2005 {published data only}
    1. Chokotho L, Hasselt E. The use of tannins in the local treatment of burn wounds: a pilot study. Malawi Medical Journal 2005;17(1):19‐20.
Choudhary 2013 {published data only}
    1. Choudhary KN, Soni PP, Sao DK, Murthy R, Deshkar AM, Nanda BR. Role of gentian violet paint in burn wound management: a prospective randomised control trial. Journal of the Indian Medical Association 2013;111(4):248‐50.
Colombo 1993 {published data only}
    1. Colombo P. Topical chloroxidating solution in wounds treatment: a controlled trial. Acta Toxicologica et Therapeutica 1993;14(2):65‐72.
Daryabeigi 2010 {published data only}
    1. Daryabeigi R, Heidari M, Hosseini SA, Omranifar M. Comparison of healing time of the 2 degree burn wounds with two dressing methods of fundermol herbal ointment and 1% silver sulfadiazine cream. Iranian Journal of Nursing and Midwifery Research 2010;15(3):97‐101.
Fisher 1968 {published data only}
    1. Fisher AJ, Morrison G, Riet Rle S. A blind trial of two aerosol sprays in the exposure treatment of burns. Suid‐Afrikaanse Tydskrif Vir Geneeskunde [South African Medical Journal] 1968;42(34):903‐5.
Gee Kee 2015 {published data only}
    1. Gee Kee E, Kimble RM, Cuttle L, Stockton K. Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial. Trials 2013;14(403):Available from .
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Helvig 1979 {published data only}
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