Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification
To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analys...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2010-09-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1699462 |
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| author | Ioannis Goutos Maria Clarke Clara Upson Patricia M. Richardson Sudip J. Ghosh |
| author_facet | Ioannis Goutos Maria Clarke Clara Upson Patricia M. Richardson Sudip J. Ghosh |
| author_sort | Ioannis Goutos |
| collection | DOAJ |
| description | To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments. |
| format | Article |
| id | doaj-art-4b2b365d18d24d5e87caf50786fc6d8b |
| institution | OA Journals |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2010-09-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-4b2b365d18d24d5e87caf50786fc6d8b2025-08-20T02:38:35ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2010-09-0143S51S6210.1055/s-0039-1699462Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classificationIoannis Goutos0Maria Clarke1Clara Upson2Patricia M. Richardson3Sudip J. Ghosh4Department of Plastic Surgery, Queen Alexandra Hospital, QUAD Building, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, United KingdomDepartments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United KingdomDepartments of Occupational Therapy and Physiotherapy, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United KingdomDepartment of Anaesthesia, St. Andrew's Centre for Plastic Surgery and Burns, East Wing, Broomfield Hospital, Court Road, Chelmsford, CM1 7ET, United KingdomDepartment of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Road, Buckinghamshire, HP21 8AL, United KingdomTo review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1699462pruritusburnitchantihistaminesgabapentin |
| spellingShingle | Ioannis Goutos Maria Clarke Clara Upson Patricia M. Richardson Sudip J. Ghosh Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification Indian Journal of Plastic Surgery pruritus burn itch antihistamines gabapentin |
| title | Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification |
| title_full | Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification |
| title_fullStr | Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification |
| title_full_unstemmed | Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification |
| title_short | Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification |
| title_sort | review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the grade classification |
| topic | pruritus burn itch antihistamines gabapentin |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1699462 |
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