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The comparison between topical antimicrobial and non‐antimicrobial agents revealed moderate to low‐certainty evidence, indicating no or little difference in time to wound healing between topical agents. participants admitted within 24 hours after injury to 1 of the 3 dedicated Dutch Burn Centres with thermal or electrical injuries involving the face There may be little or no difference in time to wound healing between topical anti‐microbial agents (Aquacel‐Ag) and non‐antimicrobial agents (MEBO) and saline‐soaked dressings) in facial burns. Data from Mabrouk 2012 not used, it was not stated or verifiable that all participants healed during the study. The certainty of a body of evidence involves consideration of within‐trial risk of bias (methodological quality), directness of evidence, heterogeneity, precision of effect estimates and risk of publication bias ( Schünemann 2019). We aimed to rate the overall certainty of evidence as high, moderate, low or very low using the GRADE approach ( GRADE 2013; Ryan 2016).
other sources of bias: baseline similarity, co‐interventions, compliance, similar timing of outcome assessment. Relatively high dropout rate in study. No information on reasons long‐term dropouts at patient level, substantial dropout. The item 'incomplete outcome data' includes a high dropout rate or an imbalance in dropout in combination with an absent ITT analysis. Seven studies showed no risk of attrition bias ( Ang 2000; Demling 2002; Hindy 2009; Horch 2005; Lehna 2017; Tsoutsos 2009; Wang 2015), in four studies risk of bias was unclear ( Demling 1999; Desai 1991; Jiaao 2011; Mabrouk 2012), and one study had a high risk of bias because of high dropout ( Oen 2012). Change in wound surface area over time: percentage of healing at 3, 5, 7 and 14 days after treatment, reported P < 0.01 at day 5, 7 and 14 days after treatment.Three studies compared topical antimicrobial versus non‐antimicrobial agents. These studies included comparisons between SSD and the non‐antimicrobial Moist Exposed Burn Ointment (MEBO) ( Ang 2000), and between a topical antimicrobial hydrocolloid dressing (Aquacel Ag) and MEBO ( Hindy 2009; Mabrouk 2012). S45 TI dressing* or pad or pads or gauze or tulle or film or bead or foam* or non‐adherent or non adherent or hydrocolloid* or hydrofibre* or hydrogel* or alginate* or plaster* or compress or absorb* or dextra* or silicon* or amnion* Number of participants: 25 (within‐patient comparison): 15 superficial degree II burns; 10 deep degree II burns. Exclusion: no informed consent, < 5 years old, not responding to tactile stimulation, not able to communicate discomfort verbally face OR facial OR nose OR ear OR ears) AND scald [Title] AND topical OR local OR ointment OR dressing OR bandage OR lotion OR cream OR gel OR solution [Interventions]
Third degree bums, to isolate the wound, reduce pain, and expedite nonsurgicaf debridement of the necrotic tissue to prepare the wound for grafting. MEBO is of pure herbal edible origin. No side effects to the product have been reported so far. except for rare allergic reactions to sesame oil.
Comparing between topical antimicrobial agents showed that topical antimicrobial agents may make no difference in time to wound healing as the evidence is low certainty. Sponsorship: quote: "None of the investigators had any financial interest in or received any benefits or privileges from the company manufacturing MEBO." Quote: "It was not possible to guarantee blinding of the observers to treatment allocation because of the presence or involvement in clinical care of most observers." One or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not prespecified.
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