What is the best antibiotic for an infected skin burn?

Best Antibiotic for an Infected Skin Burn

For infected skin burns, a broad-spectrum antibiotic regimen with coverage against both Gram-positive and Gram-negative bacteria is recommended, with piperacillin-tazobactam being the first-line choice for moderate to severe infections. 1

Understanding Burn Wound Infections

Burn wound infections are typically polymicrobial in nature. Initially, they are colonized by Gram-positive bacteria from the patient's endogenous skin flora or external environment, but within a week, Gram-negative bacteria often become predominant 1. This polymicrobial nature necessitates broad-spectrum coverage.

Antibiotic Selection Algorithm

Step 1: Assess Severity of Infection

• Mild infection (limited cellulitis, minimal systemic symptoms):

  • Amoxicillin-clavulanate 875/125 mg PO twice daily 2
  • Alternative: Doxycycline 100 mg PO twice daily 2

• Moderate to severe infection (extensive cellulitis, systemic signs of infection):

  • Piperacillin-tazobactam 3.375 g IV every 6-8 hours 1, 3
  • Alternative: Imipenem-cilastatin 1 g IV every 6-8 hours or meropenem 1 g IV every 8 hours 1

Step 2: Consider MRSA Coverage

Add MRSA coverage if:

• Local prevalence of MRSA is >20% 1
• Patient has risk factors for MRSA 1
• Infection is severe 1

MRSA coverage options:

• Vancomycin 15 mg/kg IV every 12 hours 1
• Linezolid 600 mg IV/PO every 12 hours 1
• Daptomycin 4-6 mg/kg IV daily 1

Step 3: Adjust Based on Culture Results

• Obtain deep tissue cultures before starting antibiotics 2
• Adjust therapy once culture and sensitivity results are available 2

Duration of Therapy

• Mild infections: 7-10 days 1
• Moderate to severe infections: 10-14 days 1, 2

Surgical Management

Surgical intervention is crucial and should be performed alongside antibiotic therapy:

• Debridement of necrotic tissue 1
• Early excision of eschar to decrease invasive burn wound infection 1
• Consider negative pressure wound therapy for selected cases 2

Special Considerations

For Immunocompromised Patients

• Add antifungal coverage if persistent fever despite antibacterial therapy 1
• Consider empiric vancomycin or other anti-Gram-positive agents if not already being administered 1

For Pediatric Patients

• Piperacillin-tazobactam: 60-75 mg/kg/dose of piperacillin component every 6 hours IV 1
• Adjust dosing based on weight and renal function 1

Common Pitfalls to Avoid

1. Delayed antibiotic initiation: Start antibiotics promptly for suspected infections 2
2. Inadequate debridement: Antibiotics alone are insufficient without proper wound debridement 2
3. Surface swab cultures: These often identify colonizing organisms rather than true pathogens 2
4. Prolonged antibiotic use: Continue antibiotics only until resolution of infection, not through complete wound healing 2
5. Failure to adjust pharmacokinetics: Burn patients have altered pharmacokinetic parameters requiring dosing adjustments 1

Monitoring

• Reassess after 48-72 hours to evaluate response 2
• Consider additional surgical debridement if inadequate improvement 2
• Monitor for signs of deeper infection or osteomyelitis 2

Remember that the combination of surgical debridement and appropriate antibiotic therapy is essential for successful management of infected burn wounds 1.