Systemic antimicrobial prophylaxis in burn patients: systematic review

Objective: To review studies of systemic antibiotic prophylaxis in burn patients.

Methods: Electronic databases were searched for human clinical trials performed between 1966 and 2016 that compared prophylactic systemic antibiotics with placebo or no intervention.

Results: Nineteen trials met the selection criteria. Early postburn prophylaxis was assessed in non-severe burn patients (six trials) and severe burn patients (seven trials). Antimicrobial prophylaxis showed no effectiveness for the prevention of toxic shock syndrome or burn wound infection (Grade 1C), but could be useful in patients with severe burns and requirement for mechanical ventilation (Grade 2B). Perioperative prophylaxis was assessed in six trials. Antimicrobial prophylaxis during resection of devitalized tissue is of no benefit in most burn patients (Grade 2B); however, there is insufficient evidence to make a recommendation for patients with extensive burns. Antibiotic prophylaxis may also be effective in preventing split-thickness skin graft infections in selected procedures (Grade 2B).

Conclusions: The available evidence does not support the role of systemic antibiotic prophylaxis in the management of the majority of burn patients. Nevertheless, it may be useful in patients with severe burns who require mechanical ventilation, and in selected split-thickness skin grafting procedures.