Antiseptics for Burns

Norman G, Christie J, Liu Z, Westby MJ, Jefferies JM, Hudson T, Edwards J, Mohapatra D, Hassan IA, Dumville JC

Review question

We reviewed the evidence about whether antiseptics are safe and effective for treating burn wounds.


Burn wounds cause many injuries and deaths worldwide. People with burn wounds are especially vulnerable to infections. Antiseptics prevent the growth of micro-organisms such as bacteria. They can be applied to burn wounds in dressings or washes, which may help to prevent infection and encourage wound healing. We wanted to find out if antiseptics are more effective than other types of treatment, or whether one antiseptic may be more effective than others, in reducing infection and speeding up healing.

Study characteristics

In September 2016 we searched for randomised controlled trials (RCTs) involving antiseptic treatments for burn wounds. We included 56 studies with 5807 participants. Most participants were adults with recent second-degree burns taking up less than 40% of their total body surface area. The antiseptics used included: silver-based, honey, iodine-based, chlorhexidine or polyhexanide (biguanides). Most studies compared antiseptics with a topical antibiotic (applied to the skin). A smaller number of studies compared antiseptics with a non-antibacterial treatment, or with another antiseptic.

Key results

The majority of studies compared antiseptic treatments with silver sulfadiazine (SSD), a topical antibiotic used commonly in the treatment of burns. There is low certainty evidence that some antiseptics may speed up average times to healing compared with SSD. There is also moderate certainty evidence that burns treated with honey probably heal more quickly compared with those treated with topical antibiotics. Most other comparisons did not show a clear difference between antiseptics and antibiotics.

There is evidence that burns treated with honey heal more quickly (high certainty evidence) and are more likely to heal (moderate certainty evidence) compared with those given a range of non-antibacterial treatments, some of which were unconventional. Burns treated with antiseptics such as nanocrystalline silver or merbromin may heal more quickly on average than those treated with Vaseline gauze or other non-antibacterial treatments (moderate or low certainty evidence). Comparisons of two different antiseptics were limited but average time to healing may be slightly quicker for wounds treated with povidone iodine compared with chlorhexidine (low certainty evidence). Few participants in the studies experienced serious side effects, but this was not always reported. The results do not allow us to be certain about differences in infection rates. Mortality was low where reported.

Quality of the evidence

Most studies were not well reported and this makes it difficult to be sure if they were at risk of bias. In many cases a single (often small) study provides all the evidence for the comparative effects of the different treatments; and some similar studies provided conflicting results. Where there is moderate or high certainty evidence clinicians will need to consider whether the evidence from the comparison is relevant to their patients.

This plain language summary is up to date as of September 2016.

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