What is the recommended treatment for an infected 2nd degree burn?

Treatment of Infected 2nd Degree Burns

The recommended treatment for infected second-degree burns includes wound debridement, appropriate dressing application with silver sulfadiazine cream, and targeted antibiotic therapy for systemic signs of infection. 1

Initial Management

• Immediately cool the burn with clean running water for 5-20 minutes to reduce tissue damage and pain 1
• Remove necrotic tissue through surgical debridement to decrease the bacterial burden and prevent invasive burn wound infection 1
• Clean the wound with tap water, isotonic saline, or an antiseptic solution before applying any dressing 1
• Remove jewelry from affected areas to prevent constriction as burned tissue swells 1

Topical Antimicrobial Therapy

• Apply silver sulfadiazine cream 1% as the primary topical antimicrobial agent for infected second-degree burns 2
• Apply the cream to a thickness of approximately 1/16 inch once to twice daily, ensuring burn areas are covered at all times 2
• Reapply the cream after any hydrotherapy or when removed by patient activity 2
• Continue treatment until satisfactory healing has occurred or until the burn site is ready for grafting 2
• Consider alternative topical agents in specific situations:
  • Mafenide acetate for burns with deeper infection due to its superior eschar-penetrating characteristics 3
  • Petrolatum-based antibiotic ointment, honey, or aloe vera for smaller, less severely infected burns 1

Systemic Antibiotic Therapy

• Initiate systemic antibiotics only when there are signs of invasive infection, spreading cellulitis, or systemic signs of infection 1
• Select antibiotics based on bacterial cultures, considering that burn wound infections are typically polymicrobial 1
• Target both Gram-positive bacteria (especially Staphylococcus aureus) and Gram-negative bacteria that commonly colonize burns within a week of injury 1
• Adjust antibiotic dosing to account for altered pharmacokinetic parameters in burn patients 1
• Consider MRSA coverage in areas with high MRSA prevalence (>20% of invasive hospital isolates) 1

Wound Care and Dressing Management

• Cover the wound with clean, non-adherent dressings if necessary, though silver sulfadiazine can be used without dressings 2
• Monitor for signs of worsening infection including increasing pain, redness, swelling, purulent drainage, or systemic symptoms 1
• Change dressings regularly to assess wound healing and reapply antimicrobial agents 2
• Ensure proper wound care to prevent secondary bacterial infections that can convert partial-thickness burns to full-thickness injuries requiring grafting 4

Special Considerations

• For large second-degree burns (>40% total body surface area), consider early debridement and coverage with homograft as an alternative to conservative topical antimicrobial therapy 4
• Burns involving the face, hands, feet, genitalia, or those covering >10% body surface area (5% in children) should be referred to a specialized burn center 1
• Monitor for development of multidrug-resistant infections, which are a significant cause of morbidity and mortality in burn patients 5
• Avoid routine prophylactic systemic antibiotics as they may select for multidrug-resistant bacteria without clear benefit 1

Prevention of Complications

• Control pain with appropriate analgesics such as acetaminophen or NSAIDs 1
• Monitor for signs of systemic infection that may lead to sepsis, a leading cause of death in burn patients 1, 5
• Be vigilant for conversion of second-degree burns to full-thickness (third-degree) burns due to infection, which would require surgical intervention 4, 6
• In pediatric patients, be particularly attentive to wound care as children have a higher risk of complications from burn infections 6