Topical silver sulfadiazine vs collagenase ointment for the treatment of partial thickness burns in children: a prospective randomized trial.
BACKGROUND
The 2 most commonly used topical agents for partial thickness burns are silver sulfadiazine (SSD) and collagenase ointment (CO). Silver sulfadiazine holds antibacterial properties, and eschar separation occurs naturally. Collagenase ointment is an enzyme that cleaves denatured collagen facilitating separation but has no antibacterial properties. Currently, there are no prospective comparative data in children for these 2 agents. Therefore, we conducted a prospective randomized trial.


METHODS
After institutional review board approval, patients were randomized to daily debridement with SSD or CO. Primary outcome was the need for skin grafting. Patients were treated for 2 days with SSD with subsequent randomization. Polymyxin was mixed with CO for antibacterial coverage. Debridements were performed daily for 10 days or until the burn healed. Grafting was performed after 10 days if not healed.


RESULTS
From January 2008 to January 2011, 100 patients were enrolled, with no differences in patient characteristics. There were no differences in clinical course, outcome, or need for skin grafting. Wound infections occurred in 7 patients treated with CO and 1 patient treated with SSD (P = .06). Collagenase ointment was more expensive than SSD (P < .001). However, total hospital charges did not differ.


CONCLUSIONS
There are no differences in outcomes between topical SSD or CO in the management of childhood burns results.
The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO 64108, USA. dostlie@cmh.edu
Daniel J
DJ
Ostlie
David
D
Juang
Pablo
P
Aguayo
Janine P
JP
Pettiford-Cunningham
Erin A
EA
Erkmann
Diane E
DE
Rash
Susan W
SW
Sharp
Ronald J
RJ
Sharp
Shawn D
SD
St Peter
D000287:Administration, Topical; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002056:Burns / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017364:Collagenases / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009824:Ointments; D011113:Polymyxins / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012837:Silver Sulfadiazine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016038:Skin Transplantation; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D009824:Ointments; D011113:Polymyxins; D017364:Collagenases; D012837:Silver Sulfadiazine