From the Guidelines
Prophylactic antibiotics are not routinely recommended for partial thickness burns in the inpatient setting unless there are specific indications for their use, such as signs of infection, and should be guided by the most recent and highest quality evidence available 1. When considering antibiotic use for partial thickness burns, it is essential to prioritize the prevention of morbidity, mortality, and improvement of quality of life. The use of antibiotics should be based on clinical judgment and guided by evidence-based recommendations.
Key Considerations
- Antibiotics should only be initiated if there are signs of infection such as increasing erythema beyond the burn margin, purulent discharge, foul odor, increased pain, or systemic symptoms like fever.
- If infection is suspected, empiric therapy with cefazolin 1-2g IV every 8 hours or clindamycin 600-900mg IV every 8 hours (for penicillin-allergic patients) is appropriate while awaiting culture results, as recommended by guidelines for the treatment of complicated skin and soft tissue infections 1.
- Treatment duration typically ranges from 7-14 days depending on clinical response.
- For burns with established infection, antibiotic selection should be guided by wound cultures and susceptibility testing.
- Topical antimicrobials like silver sulfadiazine cream or silver-impregnated dressings are preferred for infection prevention in partial thickness burns rather than systemic antibiotics.
- Unnecessary antibiotic use increases the risk of developing resistant organisms, Clostridioides difficile infection, and other adverse effects, as highlighted by the Surviving Sepsis Campaign guidelines 1.
Best Approach
The best approach to preventing infection in partial thickness burns involves:
- Proper wound care
- Regular dressing changes
- Debridement of devitalized tissue
- Vigilant monitoring for signs of infection By following these guidelines and considering the most recent and highest quality evidence available, healthcare providers can optimize the management of partial thickness burns and improve patient outcomes.
From the Research
Recommended Antibiotics for Partial Thickness Burns
- Ciprofloxacin has been shown to be effective in reducing infection and supporting healing in partial-thickness burns 2
- Silver sulfadiazine is a commonly used topical agent for partial thickness burns, but it may not be as effective as other treatments in reducing infection and promoting healing 3, 4
- Other antibiotics such as polymyxin, ampicillin, and gentamicin may be used in combination with topical treatments to prevent and treat infections in partial-thickness burns 3, 5, 6
Topical Treatments for Partial Thickness Burns
- Ciprofloxacin-loaded keratin hydrogels have been shown to be effective in reducing infection and promoting healing in partial-thickness burns 2
- Silver sulfadiazine cream is a commonly used topical treatment for partial-thickness burns, but it may cause eschar pigmentation that can mimic invasive wound infection 6
- Collagenase ointment is another topical treatment that can be used to facilitate debridement and promote healing in partial-thickness burns, but it may not have antibacterial properties 3
- Surfactant-based dressings, such as PluroGel, may provide a path to better optimizing the path to recovery by minimizing pain and enhancing treatment experience 4
Wound Care and Management
- Negative pressure wound therapy with silver impregnated foam and soft silicone wound contact layer may be used to facilitate residual wound closure after partial graft loss 5
- Daily debridement and dressing changes may be necessary to promote healing and prevent infection in partial-thickness burns 3, 5
- Cultured epithelial allografts or highly concentrated surfactant-based dressings may be used as alternative treatments to minimize pain and enhance treatment experience 4