From the Guidelines
Antibiotics for severe burns should be chosen based on the suspected or confirmed pathogen, with piperacillin-tazobactam plus vancomycin being a recommended combination for mixed infections, as per the guidelines from the Infectious Diseases Society of America 1. When managing severe burns, it's crucial to consider the potential for infection due to the loss of skin barrier function and the presence of a protein-rich environment that promotes bacterial growth.
- The choice of antibiotic should be guided by the suspected or confirmed pathogen, with consideration of local antimicrobial resistance patterns.
- For mixed infections, which are common in severe burns, piperacillin-tazobactam plus vancomycin is recommended, with dosages of 3.37 g every 6–8 h IV for piperacillin-tazobactam and 30 mg/kg/d in 2 divided doses IV for vancomycin in adults, as outlined in the guidelines 1.
- Other options for mixed infections include imipenem-cilastatin, meropenem, and ertapenem, with specific dosages provided for adults and children beyond the neonatal period 1.
- For infections suspected to be caused by specific pathogens like Streptococcus or Staphylococcus aureus, targeted therapy with penicillin plus clindamycin or nafcillin/oxacillin, respectively, is recommended, with dosages adjusted according to the patient's weight and renal function 1.
- The duration of antibiotic therapy typically ranges from 7 to 14 days, depending on the clinical response and the presence of any complications, as suggested by guidelines for the management of sepsis and septic shock 1.
- Regular wound cleaning, debridement of dead tissue, and appropriate dressing changes are essential components of burn care that complement antibiotic therapy, aiming to reduce the risk of infection and promote healing.
- It's also important to note that antimicrobial therapy should be reassessed daily for potential de-escalation, and the use of biomarkers like procalcitonin can assist in discontinuing empiric antibiotics when there's no evidence of infection, as recommended in the surviving sepsis campaign guidelines 1.
From the FDA Drug Label
The provided drug labels do not directly address the use of antibiotics for severe burns.
The FDA drug label does not answer the question.
From the Research
Antibiotics Used for Severe Burns
- Levofloxacin is used to treat systemic infections in severely burned patients, with a recommended dosage of 750 mg/day 2
- Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns 3
- Vancomycin and piperacillin/tazobactam are used as standard antibiotic regimens for burn patients, while colistin is used for patients who develop infections with multi-drug-resistant gram-negative pathogens 3
- Ciprofloxacin is used to treat burn patients, with a recommended dosage of 400 mg i.v. every 8 h, due to its increased clearance in burn patients 4
- Systemic antibiotics such as ampicillin, piperacillin, and teicoplanin are used to treat bloodstream infections in severely burned patients, with varying degrees of resistance observed 5
Resistance Patterns
- Acinetobacter baumannii shows high resistance rates to most antibiotics, except for polymyxin B and minocycline 5
- Pseudomonas aeruginosa is sensitive to polymyxin B but highly resistant to other antibiotics 5
- Methicillin-resistant Staphylococcus aureus (MRSA) shows higher resistance rates to most antibiotics compared to methicillin-sensitive Staphylococcus aureus (MSSA) 5
- Fungi are sensitive to amphotericin B, with low resistance rates to voriconazole, fluconazole, itraconazole, and ketoconazole 5
Treatment Considerations
- The choice of antibiotic requires a thorough knowledge of side effects, toxicity, and potential benefit 6
- Systemic antibiotics should be used for a long enough period to produce an effect, but not long enough to allow for emergence of opportunistic or resistant organisms 6
- Dosages must be adjusted based on serum concentrations when serum assays are available 6