A prospective, randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns

Abstract

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008. Patients were divided into two groups: Aquacel Ag-treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine-treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups. Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group (10 +/- 3 versus 13.7 +/- 4 days, P < 0.02) as well as pain scores at days 1, 3 and 7 (4.1 +/- 2.1, 2.1 +/- 1.8, 0.9 +/- 1.4 versus 6.1 +/- 2.3, 5.2 +/- 2.1, 3.3 +/- 1.9, respectively, P < 0.02). Total cost of treatment was 52 +/- 29 US dollars for the Aquacel Ag-treated group versus 93 +/- 36 US dollars for the silver sulfadiazine-treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.

AQUACEL® Ag BURN glove and silver sulfadiazine for the treatment of partial thickness hand burns: A retrospective review

“…The total cost of care for our study could not be established per se; however, those treated with the AQUACEL ® Ag BURN glove including the Kerlix was estimated at the time of the study at $330.00 US based on a period of 15 days compared to the SSD cohort at a daily cost of $432 US. Muangman et al [7] concurred with the cost-effective nature of AQUACEL ® Ag compared to SSD taking into consideration the hospital, travel, and total treatment cost of burn care of $52 US for the AQUACEL ® Ag cohort versus $93 US for the SSD cohort (P ≤ 0.01). Caruso et al [6] who also compared AQUACEL ® Ag and SSD calculated the total cost of care over a 21-day period to be $1,040.00 US in the AQUACEL ® Ag cohort and $1180.80 US in the SSD cohort including primary dressings, cost of labor, gauze and retention dressings, and pain medications.…”

“…Caruso et al [6] who's study compared AQUACEL ® Ag to SSD favored AQUACEL ® Ag over SSD (74% vs. 60%) with reepithelization reported to be 16 versus 17 days; however, this was not statistically significant and concurs with our finding. Furthermore, Muangman et al [7] who also compared AQUACEL ® Ag to SSD reported the time to close the wound was significantly shorter in the AQUACEL ® Ag cohort (10 vs. 13.7 days, P < 0.02) with the number of dressing changes noted to be fewer using AQUACEL ® Ag (3.5 vs. 13.7, P < 0.001). Caruso et al [14] reported 95% reepithelization or complete healing to be 11.6 days for partial thickness burns treated with AQUACEL ® Ag.…”

“…[4] However, SSD requires dressings to be changed at least once a day, and this is a traumatic and painful experience for patients and resource intensive. [4,7] Furthermore, the continued use of SSD has been reported to retard wound healing and contribute to the development of hypertrophic scarring. [8] Within the last decade, there has been a notable shift toward alternative dressings that deliver silver over a sustained period and are less resource intensive reducing the amount of dressing changes.…”

In Vitro Parallel Evaluation of Antibacterial Activity and Cytotoxicity of Commercially Available Silver-Containing Wound Dressings

“…[6][7][8][9][10] Ag + reacts with membrane proteins and the DNA of bacteria, leading to denaturation of the proteins and interference in DNA replication. 11,12 Clinical evidence on Ag dressings has accumulated from clinical trials on patients with intractable ulcers, 13,14 resulting in an international 15 Despite the beneficial effect of silver, some adverse effects of topical silver on wound healing have also been described. [16][17][18] Delayed wound healing has been explained by cytotoxic effects and histological damage resulting from excessive Ag + release to wound sites.…”

Efficiency of Microbial Cellulose Dressing in Partial-Thickness Burn Wounds

“…One of the common drugs used in these wounds is 1% silver sulfadiazine; however, silver sulfadiazine necessitates frequent dressing changes (at least once daily), and dressing changes can cause pain and local maceration, can be cytotoxic to keratinocytes as well as fibroblasts, and induce bacterial resistance. 2 Microbial cellulose is a natural polymer synthesized by Acetobactor xylinum. In 1886, A. J.…”