What antibiotics are recommended for infected burns?

Antibiotic Recommendations for Infected Burns

For hospitalized patients with infected burns, intravenous vancomycin, linezolid, daptomycin, or clindamycin are recommended as empiric therapy for MRSA coverage, along with broad-spectrum antibiotics for gram-negative coverage pending culture results. 1

Initial Assessment and Antibiotic Selection

Hospitalized Patients with Complicated Infected Burns:

• For hospitalized patients with infected burns (classified as complicated skin and soft tissue infections), empirical therapy for MRSA should be considered pending culture data 1

• Recommended MRSA coverage options include:

  • Intravenous vancomycin (15-20 mg/kg/dose every 8-12 hours) 1
  • Oral or IV linezolid (600 mg twice daily) 1
  • Daptomycin (4 mg/kg/dose IV once daily) 1
  • Telavancin (10 mg/kg/dose IV once daily) 1
  • Clindamycin (600 mg IV or PO 3 times a day) if local resistance rates are low 1

• For gram-negative coverage in burn infections, consider:

  • Piperacillin-tazobactam or ampicillin-sulbactam for broad-spectrum coverage 1, 2
  • Gentamicin for Pseudomonas aeruginosa and other gram-negative organisms commonly found in burn wounds 3, 2
  • Colistin for multi-drug resistant Pseudomonas and Acinetobacter infections 2

Outpatient Management of Minor Infected Burns:

• For minor infected burns treated as outpatients, oral antibiotic options include:
  • Clindamycin (provides coverage for both MRSA and streptococci) 1
  • Trimethoprim-sulfamethoxazole (for MRSA coverage) plus amoxicillin (for streptococcal coverage) 1
  • Doxycycline or minocycline (for MRSA coverage) plus amoxicillin (for streptococcal coverage) 1
  • Linezolid alone (covers both MRSA and streptococci) 1

Special Considerations

Pediatric Patients:

• For hospitalized children with infected burns:
  • Vancomycin is recommended as first-line therapy (15 mg/kg/dose IV every 6 hours) 1
  • Clindamycin (10-13 mg/kg/dose IV every 6-8 hours) is an option if local clindamycin resistance rates are low (<10%) 1
  • Linezolid (10 mg/kg/dose PO/IV every 8 hours for children <12 years; 600 mg twice daily for children >12 years) 1
• Tetracyclines should not be used in children <8 years of age 1

Polymicrobial Infections:

• Burn wound infections are typically polymicrobial, requiring coverage for both gram-positive and gram-negative organisms 1, 2
• Initial empiric therapy should cover Staphylococcus aureus (including MRSA), Pseudomonas aeruginosa, and other gram-negative bacteria 1, 2
• Consider adding antifungal coverage if fungal infection is suspected, particularly in extensive burns 2

Duration of Therapy and Monitoring

• Duration of therapy for infected burns typically ranges from 7-14 days, based on clinical response 1
• Obtain cultures from infected burn wounds before starting antibiotics to guide targeted therapy 1
• De-escalate antibiotic therapy based on culture and sensitivity results 1, 4
• Monitor for signs of antibiotic toxicity, particularly with aminoglycosides and vancomycin 4, 5

Prevention of Recurrent Infections

• Keep draining wounds covered with clean, dry bandages 1
• Maintain good personal hygiene with regular bathing and hand cleaning 1
• Avoid reusing or sharing personal items that have contacted infected skin 1
• Focus environmental cleaning on high-touch surfaces 1

Common Pitfalls to Avoid

• Avoid unnecessary antibiotic prophylaxis for uninfected burns, as this may lead to resistant organisms 1, 6
• Do not use rifampin as a single agent or as adjunctive therapy for burn wound infections 1
• Be aware that burn patients may have altered pharmacokinetics requiring dose adjustments 1, 7
• Do not rely solely on systemic antibiotics for treating burn wound infections; appropriate wound care and surgical debridement are essential components of treatment 1, 7