Background: Current treatment of burn wound infection (BWI) is with antibiotics and/or wound cleaning/superficial debridement. The overuse of antibiotics has contributed to antibiotic resistance. One possible solution is the use of hydrogen peroxide (H2O2). The aim of this study is to investigate the current use of H2O2 in the treatment of BWI through a comprehensive review of published evidence and a survey of current clinical practice.
Methods: A systematic review was performed on the clinical use of H2O2 in the treatment of BWI using four major search engines from inception to 1st July 2018. English-written full-text publications of any study design were included and data extraction was conducted in duplicate. An 11-question survey on the use of H2O2 in the treatment of BWI was sent to all burn services in the United Kingdom (UK).
Results: The systematic review generated 1,168 papers, with only one fulfilling inclusion criteria. This was a randomised control trial (RCT) which demonstrated that soaking grafts with 2% H2O2 prior to grafting improved graft take rate in infected burn wounds compared with grafts treated with saline prior to grafting, concluding that H2O2 can be recommended in the treatment of BWI intraoperatively. A 72.7% (16 burns services) response rate was achieved to the survey. Of these, 75% of burn services (n = 12) do not currently use H2O2 in clinical practice. Of the 25% (n = 4) which do use H2O2, no service had a protocol for its use. The most common reasons for not using H2O2 were a lack of published evidence and fear of side-effects.
Conclusion: Only 1 paper suggests H2O2 to be effective in BWI treatment and there is no national consistency or protocol for the use of H2O2 in the treatment of BWI in the UK. More large-scale research is required to determine whether H2O2 may offer a solution to the need to use antibiotics to treat BWI.
Keywords: Burns; antibiotic resistance; burn wound infection; disinfection; hydrogen peroxide; systematic review.
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