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Published on: November 6, 2018
Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study
Young Mee Choi1, Kristen Campbell2, Claire Levek2
1Pediatric Surgery, Children's Hospital Colorado.
Insights
Standard ointment dressings significantly accelerate wound healing in pediatric extremity burns compared to Mepitel Ag®. This finding suggests a more effective approach for managing these types of injuries in children.
Area of Science:
- Pediatric Burn Care
- Wound Management
- Dermatology
Background:
- Antibiotic and silver-based dressings are common in pediatric burn wound care.
- Current standard involves ointment-impregnated gauze followed by casting.
- This study compares this standard to Mepitel Ag® for extremity burns.
Purpose of the Study:
- To compare the efficacy of standard ointment-based dressings versus Mepitel Ag®.
- To evaluate time to wound healing in pediatric extremity burns.
- To assess secondary outcomes like infection and grafting rates.
Main Methods:
- A randomized treatment study involving children with extremity burns.
- Stratified randomization by burn thickness.
- Primary outcome: time to wound healing; significance set at p < 0.05.
Main Results:
- Mepitel Ag® significantly reduced the rate of wound healing (HR 0.57, p = 0.002).
- Fungal infections and skin grafting rates were similar between groups.
- Ointment dressings led to fewer clinic visits (4% vs. 27%, p = 0.004).
Conclusions:
- Standard ointment-based dressings significantly enhance wound healing rates.
- Mepitel Ag® was associated with slower healing for pediatric extremity burns.
- The standard dressing approach is more efficient, requiring fewer patient visits.
Introduction:
Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds.
Methods:
Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant.
Results:
Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag® (4% versus 27%; p = 0.004).
Conclusion:
Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag® for pediatric extremity burn injuries.
Level Of Evidence:
Treatment study; Level 1.
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