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The Cochrane Database of Systematic... Jul 2017Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after... (Meta-Analysis)
Meta-Analysis Review
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; I = 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; I = 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; I = 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; I = 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; I = 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; I = 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; I = 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; I = 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.
Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Apitherapy; Bacterial Infections; Bandages; Burns; Chlorhexidine; Disinfectants; Honey; Humans; Merbromin; Plant Preparations; Povidone-Iodine; Randomized Controlled Trials as Topic; Silver Sulfadiazine; Sodium Hypochlorite; Sulfadiazine; Wound Healing
PubMed: 28700086
DOI: 10.1002/14651858.CD011821.pub2 -
The Cochrane Database of Systematic... Sep 2020Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment.
OBJECTIVES
1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other.
DATA COLLECTION AND ANALYSIS
We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects. MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high-income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low- and middle-income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi-randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low-certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low-certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%, colostrum, bacitracin-phenacaine ointment). There was only very low-certainty evidence on CUE (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low-certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events). Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low-certainty and was extremely limited.
AUTHORS' CONCLUSIONS
There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate-certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone-iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum.
Topics: Anti-Infective Agents; Bias; Blindness; Erythromycin; Humans; Infant, Newborn; Ophthalmia Neonatorum; Povidone-Iodine; Randomized Controlled Trials as Topic; Silver Nitrate; Tetracycline; Trachoma; Vision Disorders
PubMed: 32959365
DOI: 10.1002/14651858.CD001862.pub4 -
Journal of Dentistry Mar 2024To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults.
METHODS
Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment.
RESULTS
Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls.
CONCLUSION
The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity.
CLINICAL SIGNIFICANCE
SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.
Topics: Humans; Cariostatic Agents; Dental Caries; Dentin Sensitivity; Fluorides, Topical; Pain; Quality of Life; Quaternary Ammonium Compounds; Silver Compounds
PubMed: 38301767
DOI: 10.1016/j.jdent.2024.104868 -
Journal of Pain and Symptom Management Jun 2021Topical management is the main form of control of signs and symptoms regarding malignant wounds (MWs) arising from tumor progression on the skin. Nevertheless, few... (Review)
Review
CONTEXT
Topical management is the main form of control of signs and symptoms regarding malignant wounds (MWs) arising from tumor progression on the skin. Nevertheless, few studies have explored this theme and evidence on the effectiveness of the methods used to control bleeding is unknown, leading to a lack of consensus to support clinical practice.
OBJECTIVES
Identify and evaluate current evidence on topical MW hemostasis from breast cancer and suggest new topics for future research.
METHODS
This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. Seven indexed databases were consulted using the terms: "breast neoplasms"; "breast cancer"; "malignant fungating wounds"; "malignant wounds"; "bleeding."
RESULTS
From the 112 articles identified in total, six were included in this review: a descriptive cohort study (n = 32), two case series (n = 21) and three case reports (n = 3). Fifty-six patients were exposed to 11 types of topical treatments using calcium alginate, surgical hemostats, adrenaline, nonadherent dressings, silver nitrate, modified Mohs Paste, and 10% formalin. There were no reports of significant adverse effects.
CONCLUSION
Although studies have promoted positive results of topical hemostasis, scientific evidence is still weak and arises from studies with poor methodological quality. Randomized controlled trials were not identified. The results highlight the crucial need for pilot studies to evaluate effect size, study procedures, and measurable results.
Topics: Administration, Topical; Bandages; Breast Neoplasms; Cohort Studies; Female; Humans
PubMed: 33096218
DOI: 10.1016/j.jpainsymman.2020.10.020 -
BMC Infectious Diseases Mar 2021Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations...
BACKGROUND
Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established.
OBJECTIVE
To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx.
METHODS
A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP).
RESULTS
The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20-33%; positive NP, 1-28% and pneumonia, 3-8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0-15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4-33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0-4% developed chlamydial pneumonia.
CONCLUSION
Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Chlamydia Infections; Chlamydia trachomatis; Conjunctivitis, Inclusion; Female; Humans; Incidence; Infant, Newborn; Pregnancy
PubMed: 33731049
DOI: 10.1186/s12879-021-05974-3 -
Australian Journal of General Practice Aug 2021Umbilical granuloma is a common condition in infants. The aim of this study was to systematically review randomised controlled trials (RCTs) of topical treatment options...
BACKGROUND AND OBJECTIVES
Umbilical granuloma is a common condition in infants. The aim of this study was to systematically review randomised controlled trials (RCTs) of topical treatment options for umbilical granuloma.
METHOD
PubMed, Embase, Cochrane Library, Google Scholar and grey literature were searched in September 2020.
RESULTS
Eleven RCTs (n = 890) that studied the use of silver nitrate, topical steroids, ethanol wipes, electrocautery, cryocautery, copper sulphate and common salt were included. Common salt achieved resolution in >90% of cases in five studies and 54-80% in two studies. Topical steroids, silver nitrate, copper sulphate and cryocautery achieved resolution in >90% and ethanol wipes in 50-65% of cases. Local side effects reported with topical steroids, silver nitrate, cryocautery and electrocautery varied in each study. Salt application did not cause side effects. The risk of bias was high in many RCTs.
DISCUSSION
While the majority of the interventions were effective in treating umbilical granuloma, salt application appears to be simple and effective, with minimal complications.
Topics: Humans; Infant; Administration, Topical; Granuloma; Randomized Controlled Trials as Topic
PubMed: 34333576
DOI: 10.31128/AJGP-04-20-5371 -
Acta Otorhinolaryngologica Italica :... Aug 2019
Meta-Analysis
Topics: Adult; Cautery; Databases, Factual; Drug Combinations; Electrocoagulation; Embolism; Endoscopy; Endovascular Procedures; Epistaxis; Gelatin Sponge, Absorbable; Humans; Laser Therapy; Silver Nitrate; Tranexamic Acid
PubMed: 30933179
DOI: 10.14639/0392-100X-2155