A comparison of topical diphenylhydantoin with a standard therapy in burn wounds at Muhimbili National Hospital, Dar es Salaam, Tanzania.

Abstract

A prospective randomized controlled study was done at Muhimbili National hospital in adult and paediatric surgical wards to compare topically applied diphenylhydantoin (phenytoin) with a standard therapy (silverex) in the treatment of small to moderate 20 burn wounds. Comparison was made in terms of rate of healing, effect on burn wound pain, elimination of burn wound infections, hospitalization period and the outcome of wounds. Sixty four patients were enrolled in the study between July 2000 and February 2001. Daily cleaning of wounds was done with normal saline and then either diphenylhydantoin powder or silverex powder was sprinkled on the wounds. Parameters for observation included pus discharge, smell, pain, wound size reduction and, wound swab cultures on three occasions. Manual data analysis and Epi Info 2000 computer Programme was used for statistical testing of results. The majority of patients in the study were children under five (67.2%), 51.6% of patients were males and 48.4% were females. Pus discharge was noted in 59.4% of patients on diphenylhydantoin and in 75% of patients on the standard therapy during the study. This difference was

viii not statistically significant. Significant reduction In bacterial contamination of wounds was noted in diphenylhydantoin-treated wounds (P=O.OOl). Also significant relief of pain was noted in patients managed with diphenylhydantoin (P=O.Ol).Diphenylhydantoin showed faster wound healing, better wound outcome and, a shorter period of hospitalization when compared to standard therapy. The findings indicate that the treatment of small to moderate burn wounds can be improved with the use of topical diphenylhydantoin powder. Diphenylhydantoin reduces wound pain and produces a highly significant reduction in positive bacterial cultures of treated wounds, reducing the need for analgesics and antibiotics in these patients. There were no adverse effects due to diphenylhydantoin noted during the study. This drug is cheap and easy to use, and making it widely available countrywide for treatment of burn wounds may prove highly beneficial