What antibiotic is used for burn treatment?

From the Guidelines

Systemic antibiotic prophylaxis should be administered to burn patients in the first 4-14 days to significantly reduce all-cause mortality by nearly half. When considering antibiotic treatment for burns, it is crucial to prioritize the reduction of morbidity, mortality, and improvement of quality of life. According to the 2023 WSES guidelines on the management of trauma in elderly and frail patients 1, infections among burn patients are common and are associated with a high mortality rate.

The use of systemic antibiotic prophylaxis has been shown to be beneficial in reducing mortality rates. A review of 36 RCTs (2117 participants) by Barajas-Nava 1 found that systemic antibiotic prophylaxis was evaluated in three trials (119 participants) and there was no evidence of an effect on rates of burn wound infection. However, systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia.

Some key points to consider when treating burns with antibiotics include:

• The role of adequate source control, including surgical removal of contaminated material and areas of necrosis, and protection of the exposed lesion, is crucial in decreasing the infective risk 1.
• Topical antibiotic prophylaxis applied to burn wounds had no beneficial effects, and silver sulfadiazine was associated with a statistically significant increase in burn wound infection and longer length of hospital stay compared with dressings/skin substitute 1.
• Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of the review 1.

It is essential to note that the treatment of burns with antibiotics should be individualized, and the decision to use systemic or topical antibiotics should be based on the severity of the burn, the presence of infection, and the patient's overall health status.

From the FDA Drug Label

Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The antibiotic for burns is silver sulfadiazine (TOP), as it is indicated for the prevention and treatment of wound sepsis in patients with second and third degree burns 2.

• Key points:
  • Indicated for second and third degree burns
  • Used as an adjunct for the prevention and treatment of wound sepsis
  • Topical antimicrobial drug

From the Research

Antibiotics for Burns

• The use of antibiotics in burn patients is crucial to prevent infection, with silver sulfadiazine being an effective agent with low toxicity and few side effects 3.
• Other topical treatments for burns include silver nitrate, mafenide acetate, and povidone-iodine complex, as well as systemic antibiotics 4.
• The management of antibiotics for burn patients involves considering key points such as when to use or not, time of onset, bactericidia, combination, adaptation, de-escalation, treatment duration, and regimen based on pharmacokinetic and pharmacodynamic characteristics 5.
• Current pharmacotherapy for severe burns includes the use of topical and systemic antibiotics, as well as supportive therapy and pharmacological manipulation to ameliorate the hypermetabolic response to burn injury 6.
• Meropenem is a broad-spectrum antibacterial agent that has been shown to be effective in the treatment of serious bacterial infections, including those caused by Gram-positive and Gram-negative pathogens 7.

Types of Antibiotics

• Silver sulfadiazine is an effective topical antibiotic for burns, with low toxicity and few side effects 3.
• Meropenem is a broad-spectrum antibacterial agent that is suitable for administration as an intravenous bolus or infusion, and has a low propensity for inducing seizures 7.
• Other antibiotics that may be used in burn patients include mafenide acetate, povidone-iodine complex, and ceftazidime 4, 6.

Considerations for Antibiotic Use

• The emergence of resistant Gram-negative bacilli, including Pseudomonas aeruginosa, is a major concern in the use of antibiotics for burns 3.
• The development of hospital-acquired multi-resistance to antibiotics is a significant problem in burn care, and requires careful management of antibiotic use 5.
• The use of antibiotics in burn patients should be guided by pharmacokinetic and pharmacodynamic characteristics, as well as considerations of bactericidia, combination, adaptation, de-escalation, and treatment duration 5, 6.