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: