Survival benefit conferred by topical antimicrobial preparations in burn patients: a historical perspective.
BACKGROUND
Topical antimicrobial agents have proven efficacy in preventing life-threatening invasive burn wound infection. Under wartime or mass-casualty conditions, however, there may be an inadequate supply of these agents. This study aimed to identify those patients most likely to benefit therefrom.


METHODS
Logistical regression analysis of data from the U.S. Army Burn Center was performed. Mortality data for the period immediately preceding the introduction of topical mafenide acetate (MA) (1950-1963) were compared with data for the subsequent period (1964-1968). During the second period, MA was routinely applied but treatment was otherwise similar. The mortality decrement attributed to MA was determined for various ages and burn sizes.


RESULTS
For patients of combatant age (20-50 years), MA was associated with a greater than 10% reduction in mortality for those with burns of 40-79% of the total body surface area (TBSA). Only a minimal effect on mortality was noted for those patients with burns smaller than 40% or greater than 79%.


CONCLUSIONS
When resources are limited, topical therapy (specifically, MA) is likely to confer the greatest survival benefit for combatants with burns of 40-79% TBSA.
Brown
Timothy P La H
TP
The Burns Unit, Middlemore Hospital, Auckland, New Zealand.
Cancio
Leopoldo C
LC
McManus
Albert T
AT
Mason
Arthur D
AD
D000287:Administration, Topical; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002056:Burns / Q000188:drug therapy / Q000401:mortality*; D004189:Disaster Planning; D006801:Humans; D016015:Logistic Models; D008272:Mafenide / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D015996:Survival Rate
D000891:Anti-Infective Agents, Local; D008272:Mafenide