Evaluating the Role of Alternative Therapy in Burn Wound Management: Randomized Trial Comparing MEBO with Conventional Methods in the Management of Patients with Second-degree Burns

Ang ES, et al. Medscape General Medicine 2001; 3(12):3-18
 
This trial demonstrates similar outcomes when partial-thickness burns covering less than 40 % BSA are treated with C or MEBO.  Time taken for 75 % of the original BSA to epithelialize was taken as the end point for in-hospital healing in our study.  Patients treated with MEBO took 17 days on average to heal vs 20 days when on C.  The rate of MRSA presence in MEBO wounds was similar to that in C wounds.  In addition, Acinetobacter baumannii and Pseudomonas aeruginosa, 2 gram-negative organisms that pose a particular problem in our Burns Center, continued to persist in the MEBO®-treated wounds as compared with the relative absence of these organisms by the second week postburn in C wounds.  This shows that MEBO is not bactericidal against potentially pathogenic microorganisms as previously claimed.
 
With regard to pain control, MEBO imparts a greater analgesic effect than that afforded by C, especially in the first 5 days following injury.  Effective pain relief during this period is advantageous to modulate the acute immune response.  This is reflected by the increased number of patients requesting opiate analgesics in the C group and the more than double mean dose of Pethidine administered in the first week to this group.  The analgesic effect is attributable to the presence of the layer of ointment that shields the burn wound from the external environment.  Notably, as therapy progressed, this analgesic advantage was reduced, possibly due to the daily removal of accumulated MEBO at this stage.
 
From a practical standpoint, a straw poll of the nurses indicated that they found it easier to manage facial and neck burns with MEBO, as it did not require the elaborate bandaging that is required with silver sulfadiazine.  Additionally, occupational therapy in MEBO-managed hand burns was instituted earlier as there was no hindrance from bulky dressings, thus improving rehabilitation prospects in these cases.
 
From the results of this prospective randomized, controlled trial, it is concluded that MEBO is as effective as the conventional approach in the management of second-degree burns, though it is not the panacea for all burn wounds as claimed.  It may be useful alternative in burn injuries involving certain anatomical sites such as the face, neck, and hands.  MEBO is less expensive than conventional treatment and provides better pain relief in the first 5 days after burns.  In addition, as MEBO is conveniently stored in large quantities, portable, easily dispensable, and applied even by semiskilled personnel, its use may be advantageous in mass casualty situations before evacuation to definitive burn care facilities.