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Prophylactic antibiotics for burns patients: systematic review and meta-analysis

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c241 (Published 15 February 2010) Cite this as: BMJ 2010;340:c241
  1. Tomer Avni, resident 1,
  2. Ariela Levcovich, senior physician 2,
  3. Dean D Ad-El, head of department3,
  4. Leonard Leibovici, head of department1,
  5. Mical Paul, consultant4
  1. 1Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel-Aviv University, Israel
  2. 2Department of Medicine B, Rabin Medical Center, Beilinson Hospital
  3. 3Department of Plastic Surgery and Burns, Rabin Medical Center, Beilinson Hospital
  4. 4Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital
  1. Correspondence to: M Paul paulm{at}post.tau.ac.il
  • Accepted 24 November 2009

Abstract

Objective To assess the evidence for prophylactic treatment with systemic antibiotics in burns patients.

Design Systematic review and meta-analysis of randomised or quasi-randomised controlled trials recruiting burns inpatients that compared antibiotic prophylaxis (systemic, non-absorbable, or topical) with placebo or no treatment.

Data sources PubMed, Cochrane Library, LILACS, Embase, conference proceedings, and bibliographies. No language, date, or publication status restrictions were imposed.

Review methods Two reviewers independently extracted data. The primary outcome was all cause mortality. Risk or rate ratios with 95% confidence intervals were pooled with a fixed effect model if no heterogeneity was present.

Results 17 trials were included. Trials that assessed systemic antibiotic prophylaxis given for 4-14 days after admission showed a significant reduction in all cause mortality (risk ratio 0.54, 95% confidence interval 0.34 to 0.87, five trials). The corresponding number needed to treat was 8 (5 to 33), with a control event rate of 26%. Perioperative non-absorbable or topical antibiotics alone did not significantly affect mortality. There was a reduction in pneumonia with systemic prophylaxis and a reduction in wound infections with perioperative prophylaxis. Staphylococcus aureus infection or colonisation was reduced with anti-staphylococcal antibiotics. In three trials, resistance to the antibiotic used for prophylaxis significantly increased (rate ratio 2.84, 1.38 to 5.83). The overall methodological quality of the trials was poor.

Conclusions Prophylaxis with systemic antibiotics has a beneficial effect in burns patients, but the methodological quality of the data is weak. As such prophylaxis is currently not recommended for patients with severe burns other than perioperatively, there is a need for randomised controlled trials to assess its use.

Footnotes

  • Contributors: MP was responsible for conception of the trial and is guarantor. TA, AL, and MP wrote the protocol, carried out searches, extracted and analysed the data, and wrote the manuscript. All authors critically revised the manuscript.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Data sharing: Analyses in RevMan software are available from the corresponding author at paulm@post.tau.ac.il.

  • Accepted 24 November 2009

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