• Barclay T Stewart, Adam Gyedu, Pius Agbenorku, Richcane Amankwa, Adam L Kushner, and Nicole Gibran.
• Department of Surgery, University of Washington, Seattle, USA; Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: stewarb@uw.edu.
• Int J Surg. 2015 Sep 1; 21: 168-72.

BackgroundBurns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection.MethodsA best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality?ResultsFrom 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses.ConclusionOn the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury.Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

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