Diphoterine untangled: a systematic review

Skaria Alexander1, Jason Wasiak2, Heather Cleland3

1 Victorian Adult Burns Service, the Alfred Hospital, Commercial Road, Prahran, VIC 3181, ksalexander@doctors.org.uk
2 The Epworth Hospital, 89 Bridge Road, Richmond VIC 3121, Jason.wasiak@epworth.org.au
3 Victorian Adult Burns Service, the Alfred Hospital, Commercial Road, Prahran, VIC 3181, h.cleland@alfred.org.au

Diphoterine is a hypertonic, amphoteric, polyvalent and chelating decontamination solution that is used in the treatment of cutaneous and ocular chemical burns. There is debate in the literature as to its efficacy and safety with contrasting conclusions.
A structured literature search was performed on Ovid MEDLINE, EMBASE and BIOLOGICAL ABSTRACTS from 1946 to 2016, using a series of keywords. Studies were selected on specific inclusion/exclusion criteria and data was extracted and assessed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) Risk of Bias (RoB) tool for in vivo animal studies and Cochrane Handbook for Systematic Reviews of Interventions for clinical studies.
36 studies were identified as potentially relevant from the search, of which 14 studies (9 preclinical, 5 clinical) satisfied inclusion criteria and formed the basis of this review. Of the preclinical studies, none of them satisfied all the criteria of the SYRCLE RoB tool. Using the Cochrane tool for the 5 clinical studies: 1 was assessed as good, 2 as satisfactory and 2 as poor
No adverse events attributable to diphoterine were reported. Pre clinical studies showed a faster resolution of pH and reduced tissue necrosis with diphoterine. Clinical studies showed reduced tissue necrosis/severity of symptoms, faster pH resolution and a reduction in pain when using diphoterine. There was no change in length of hospitalisation or need for surgery.
The methodology of the published literature for diphoterine is generally poor.
Diphoterine appears to be safe to use.
We suggest that immediate decontamination of a chemical burn is imperative, but that outcomes may be better with diphoterine.
However, well-constructed clinical trials producing robust data are necessary before fully endorsing its effectiveness.

Key Words
Diphoterine, chemical burn, systematic review

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