From the Guidelines
For outpatient burn treatment, topical antibiotics are the preferred first-line treatment, with silver sulfadiazine 1% cream being the most commonly used option, applied once or twice daily to clean wounds. When considering systemic antibiotics for burn outpatients, it's crucial to weigh the risks and benefits, as prophylactic use can lead to resistant organisms. However, if signs of infection are present, such as increasing pain, redness, purulent discharge, or systemic symptoms like fever, empiric oral antibiotic options may be considered. According to the guidelines for the treatment of skin and soft tissue infections 1, for empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid. The more recent guidelines from 2014 1 provide detailed antimicrobial agent recommendations for various types of skin and soft tissue infections, including those that might be relevant to burn patients, such as mixed infections, streptococcal infections, and staphylococcal infections. However, for burn outpatients specifically, the focus remains on topical treatments unless clear signs of infection necessitate systemic antibiotics, in which case clindamycin 300-450mg three times daily for 7-10 days could be an option, with adjustments based on culture results 1. It's essential to prioritize the use of topical antibiotics for burn wound care to minimize the risk of antibiotic resistance and to reserve systemic antibiotics for cases where there is a clear indication of infection. Key considerations include the type of burn, the presence of signs of infection, and the potential for antibiotic resistance, guiding the decision towards topical treatments like silver sulfadiazine as the first line, with systemic options like clindamycin considered only when necessary. The rationale behind this approach is to provide effective antimicrobial coverage while minimizing the risk of contributing to antibiotic resistance, thus optimizing outcomes in terms of morbidity, mortality, and quality of life for burn outpatients.
From the Research
Antibiotics for Outpatient Burn Treatment
- The choice of antibiotics for outpatient burn treatment depends on the severity of the burn, the presence of infection, and the suspected or confirmed causative organisms 2.
- For mild infections in stable clinical conditions, close monitoring is recommended, while severe infections require treatment according to international sepsis guidelines and the Tarragona principle 3.
- The most commonly prescribed empirical antibiotics for burn wound infections are amikacin and levofloxacin, with the cultured organisms showing high sensitivity and specificity to these antibiotics 2.
- The source of infection determines the most likely organism and its sensitivity profile, with Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa being the most prevalent causes of burn wound infection 2.
- Burn wounds are initially sterile but become colonized by gram-positive organisms and subsequently by gram-negative organisms, with some populations being especially susceptible to initial or subsequent colonization by drug-resistant organisms 4.
Considerations for Antibiotic Use
- Antibiotic prophylaxis has shown no effectiveness in preventing toxic shock syndrome in low-grade burns, but may be useful in patients with severe burns who require mechanical ventilation 3.
- The benefit of long-term systemic antibiotic prophylaxis in the majority of burn patients is not evident, and antibiotic stewardship is essential to prevent misuse and promote appropriate use of antibiotics 5, 3.
- Early excision and grafting, appropriate wound care, and nutritional support are also important in preventing wound infections and promoting healing 4.