What is the best antibiotic (abx) choice for a scald burn from boiling water on the hand?

From the Guidelines

For a scald burn from boiling water on the hand, the best antibiotic choice is typically not needed for initial treatment, but if infection develops, oral cephalexin 500mg four times daily for 7-10 days is often a good first choice, as it covers common skin bacteria like Staphylococcus and Streptococcus, according to the principles outlined in the 2018 WSES/SIS-E consensus conference recommendations 1. The primary treatment should focus on proper wound care including:

• Cooling the burn with cool (not cold) running water for about 20 minutes
• Gently cleaning with mild soap and water
• Applying a thin layer of petroleum jelly or an antibiotic ointment like bacitracin or polysporin
• Covering with a sterile, non-stick bandage Antibiotics should only be prescribed if there are signs of infection such as:
• Increasing pain
• Redness extending beyond the burn area
• Swelling
• Warmth
• Pus
• Fever It's essential to note that burn wound infections can be polymicrobial, and bacterial cultures can aid in the selection of an appropriate antibiotic, especially in cases of bacterial drug resistance, as mentioned in the study by Sartelli et al. 1. For patients with penicillin allergy, clindamycin 300mg four times daily for 7-10 days is an alternative, but the choice of antibiotic should be guided by the results of bacterial cultures and susceptibility testing, if available. Deep burns, burns covering large areas, or burns showing signs of serious infection should be evaluated by a healthcare provider immediately, as they may require different management including possible intravenous antibiotics or specialized wound care, as emphasized in the 2018 WSES/SIS-E consensus conference recommendations 1.

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 best antibiotic choice for a scald burn from boiling water on the hand 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

Best Antibiotic Choice for Scald Burn from Boiling Water on the Hand

• The best antibiotic choice for a scald burn from boiling water on the hand is not explicitly stated in the provided studies, but some studies suggest the use of topical antimicrobial agents such as silver sulfadiazine 3, 4, 5.
• However, it's worth noting that the use of silver sulfadiazine has been associated with an increased risk of burn wound infection and longer hospital stays 5.
• Other studies suggest that prophylactic antibiotics are not indicated for most patients with burns, and that the goal of therapy is to manage pain, facilitate healing, minimize scarring, and achieve return to function 4.
• For hand burns, which are considered high-risk for infection, some studies recommend the use of antibiotics such as dicloxacillin, cephalexin, clindamycin, or erythromycin 6.
• It's also important to note that the management of burn wounds requires a comprehensive approach, including wound cleaning, dressing, and pain management, in addition to the use of antimicrobial agents 3, 4, 7.

Topical Antimicrobial Agents

• Silver sulfadiazine is a commonly used topical antimicrobial agent for burn wound care, but its use has been associated with increased risk of infection and longer hospital stays 5.
• Other topical antimicrobial agents, such as mafenide acetate, nitrofurazone, and chlorhexidine preparations, may be useful in specific clinical situations 3.
• The choice of topical antimicrobial agent should be based on the individual patient's needs and the specific characteristics of the burn wound 3, 4, 7.

Systemic Antibiotics

• Systemic antibiotic prophylaxis may be considered for patients with high-risk burns, such as hand burns, but its use should be based on individual patient needs and the specific characteristics of the burn wound 6, 5.
• The use of systemic antibiotics should be guided by clinical judgment and the results of microbiological cultures, when available 6, 5.