Topical silver sulfadiazine vs collagenase ointment for the treatment of partial thickness burns in children: a prospective randomized trial

Healing incisional surgical wounds using Rose Hip oil in rats

“…Proteolytic enzymes have been used in wound healing for many years and the most commonly used enzymes are fibrinolysin/DNAse and collagenase [12,13,14], where collagenases act by degrading native helical collagen fibrils [15]. Recently, Tallis et al (2013) showed that the collagenase ointment is tolerable and clinically effective in providing non-viable tissue removal and allow effective scar [16].…”

Comparative cost and clinical effectiveness of clostridial collagenase ointment for chronic dermal ulcers

“…Time to clean wound bed (mean: 9.3 vs 11.6 days) and time to epithelialization (mean: 19.0 vs 22.1 days) were both numerically faster in sites treated with CCO compared with those treated with silver sulfadiazine, but the difference did not reach statistical significance [25]. Another prospective, randomized trial comparing CCO/polymyxin with silver sulfadiazine performed in 100 children with partial-thickness burns found no differences in outcomes in skin graft rates, length of stay and hospital costs between treatment groups [29]. The similarities in overall costs between treatment groups support the finding that the more significant charges of hospital room, treatment room times and operative interventions far outweigh the minimal difference in topical agent expense, so that agent choice should not be determined by agent cost [29].…”

“…An examination of the individual studies included in this adverse event analysis reported infrequent pruritus, rash, edema, erythema (one case in one study), burning sensation at wound site (similar frequency between groups in several studies), burn bed infection (in a single study, seven cases with collagenase vs one case in control group), herpes infection (one case in one study), mild bleeding (one case in one study) and cellulitis (several cases in several studies). However, the risk ratio of developing cellulitis was not found to be statistically significantly different between treatment groups on subgroup analysis by Patry et al [21][22][23][24][25][26][27][28][29][30], and a high risk of bias was noted by the Cochrane risk of bias tool among the majority of RCTs included. The systematic review and meta-analysis contained information from some, but not all, of the more recent studies in the literature as it was limited to RCTs, excluding cohort (prospective or retrospective) studies.…”

“…The effectiveness of CCO in burn treatment has been demonstrated in several studies compared with surgical excision, silver sulfadiazine or MD, in both the hospital and outpatient burn center (Table 4) [25,29,[44][45]. Hansbrough et al conducted a trial in 79 patients (age range: 5-60 years) with partial-thickness burn wounds in which paired wound sites of comparable size and severity in each patient were randomized to treatment with either CCO with polymyxin B sulfate/bacitracin powder or silver sulfadiazine.…”

“…Another prospective, randomized trial comparing CCO/polymyxin with silver sulfadiazine performed in 100 children with partial-thickness burns found no differences in outcomes in skin graft rates, length of stay and hospital costs between treatment groups [29]. The similarities in overall costs between treatment groups support the finding that the more significant charges of hospital room, treatment room times and operative interventions far outweigh the minimal difference in topical agent expense, so that agent choice should not be determined by agent cost [29].…”