From the Guidelines
For burns, it is recommended to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling with running water, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing small partial-thickness burns at home, the following options may be considered:
- Petrolatum
- Petrolatum-based antibiotic ointment
- Honey
- Aloe vera These options can be applied after cooling the burn with running water, and a clean nonadherent dressing can be used to cover the open burn wound 1. It is essential to note that these recommendations are for small partial-thickness burns being managed at home, and it is crucial to seek medical attention for more severe burns or if there are any concerns about the burn or the patient's condition. Additionally, over-the-counter pain medications may be given for pain from thermal burns, as suggested by the guidelines 1. It is also important to avoid using certain substances on burns, such as butter or oils, as they can trap heat and increase infection risk, although this is not explicitly stated in the provided guidelines, it is a general principle of burn care.
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 burn wounds are then cleansed and debrided; silver sulfadiazine cream, USP 1% is then applied under sterile conditions.
The best ointment to use on a burn is silver sulfadiazine cream, USP 1% 2, as it is indicated for the prevention and treatment of wound sepsis in patients with second and third degree burns. It should be applied once to twice daily to a thickness of approximately one sixteenth of an inch 2. Key points to consider when using this ointment include:
- Applying the cream under sterile conditions
- Covering the burn areas with the cream at all times
- Reapplying the cream immediately after hydrotherapy
- Continuing treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2
From the Research
Burn Ointment Options
The choice of ointment for burn treatment depends on various factors, including the depth and severity of the burn. Some studies suggest the following options:
- Collagenase ointment and polymyxin B sulfate/bacitracin spray: This combination has been shown to result in significantly shorter time to achieve a clean wound bed and more rapid wound healing compared to silver sulfadiazine cream in partial-thickness burns 3.
- Aloe Vera gel: A study found that Aloe Vera gel was more effective than 1% silver sulfadiazine cream in promoting wound epithelialization, pain relief, and cost-effectiveness in patients with superficial and partial thickness burns 4.
- Silver sulfadiazine cream: Although it has been compared to other treatments, silver sulfadiazine cream is still a commonly used topical antimicrobial agent in burn care 3, 4, 5.
- Compounded preparations: Some studies have investigated the effectiveness of compounded preparations, such as 1:1:1 + Double Antibiotic and 3:1 + Double Antibiotic, which have shown promising results against bacterial isolates from burn wounds 5.
Considerations for Topical Antimicrobial Agents
When selecting a topical antimicrobial agent for burn wounds, it is essential to consider the following:
- Depth of the burn: The goal for superficial burns is to optimize re-epithelialization, while for deep burns, the goal is to minimize microbial growth until the wound is grafted 6.
- Spectrum of activity: Different topical agents have varying levels of effectiveness against different microorganisms, and some may be more effective than others in preventing infection and promoting wound healing 5.
- Potential for resistance: The development of topical antimicrobial resistance is a concern and requires further study 5.