Evidence behind the WHO guidelines: hospital care for children: what is the role of prophylactic antibiotics in the management of burns?

Thermal injuries are a major source of morbidity and mortality in the developing world [1]. There are over 300 000 deaths each year resulting directly from fire-related burns alone, with many more deaths from scalds, electrical and other forms of burns, for which global data are not available [1]. It has been estimated that 75% of all deaths following thermal injuries are related to infection [2]. Optimal management of burns, particularly to prevent and treat infection is therefore essential to improve outcomes [3]. Traditionally, topical antibiotics and antibioticimpregnated dressings have been used together with systemic antibiotics to prevent and treat infection [4–7]. However, there is a paucity of evidence to support the continued use of systemic antibiotic as prophylaxis to prevent infection following burns. In many centres, including those in the developing world, hospitals have developed local management protocols with systemic antibiotic prophylaxis in patients who have a positive microbiological culture from a burn site in an attempt to prevent wound infection and septicaemia [6, 7]. Despite the large number of paediatric burn patients in developing countries, it is still unknown if the use of prophylactic systemic antibiotics is effective and cost-efficient in preventing infective complications. There is a lack of systematic research, standardized treatment protocols, compounded by limited resources [8]. This review evaluates the evidence for efficacy of systemic [oral (PO) and intravenous (IV)] antibiotic prophylaxis in delaying or preventing infection of burns. This is an especially important issue for severe burns requiring operative wound debridement, surgical manipulation and skin grafting.