What medications are used to treat burns?

Medications for Burns Treatment

Silver sulfadiazine is the most widely used topical medication for burn treatment, applied once to twice daily to a thickness of approximately 1/16 inch to prevent and control infection in burn wounds. 1, 2

Initial Management and Pain Control

• Cool the burn with cold tap water (15° to 25°C) for up to 40 minutes for burns covering <20% total body surface area (TBSA) in adults or <10% in children to limit burn depth and reduce pain 2
• Avoid cooling large burns or using ice directly as this can cause tissue ischemia and hypothermia 2
• For pain management, use a multimodal approach including:
  • Short-acting opioids and ketamine for managing burn-induced pain 2
  • Acetaminophen administered intravenously is effective and safe in elderly trauma patients 3
  • Inhaled nitrous oxide when intravenous access is unavailable 2
  • Non-pharmacological treatments such as cooling limited burned surfaces 2

Topical Antimicrobial Medications

Silver Sulfadiazine

• First-line topical antimicrobial for most burn wounds 1, 2
• Apply once to twice daily to a thickness of approximately 1/16 inch 1
• Reapply after hydrotherapy or when removed by patient activity 1
• May be associated with prolonged healing if used for a long time on superficial burns 4
• Should be continued until satisfactory healing or until the burn site is ready for grafting 1

Mafenide Acetate

• Superior eschar-penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis 5
• Potential adverse effects include pain/burning sensation, rash, pruritus, and metabolic acidosis 6
• Duration and area of application must be limited due to systemic toxicity with prolonged or extensive use 5

Other Topical Agents

• Petrolatum or petrolatum-based antibiotic ointment for superficial burns 4
• Bacitracin and neomycin are options for topical antimicrobial therapy 7
• Honey or aloe vera can be applied to superficial burns 4, 8

Wound Care Considerations

• Clean burn wounds with tap water, isotonic saline, or an antiseptic solution in a clean environment 2, 4
• Choose dressing type based on TBSA, local wound appearance, and patient's general condition 2
• Cover wounds with antibiotic ointment or cream and a clean occlusive dressing for superficial wounds 2
• When applying dressings on limbs, prevent bandages from creating a tourniquet effect 8
• Monitor distal perfusion in case of circular dressings 8
• Ideally, dressings should be re-evaluated daily 8

Important Cautions

• Topical antibiotics should not be used as first-line treatment but reserved for infected wounds only 2, 4
• Systemic antibiotic prophylaxis should not be administered routinely to burns patients 2
• Avoid applying ice directly to burns as it can cause further tissue damage 2, 4
• Do not use external cooling devices (e.g., Water-Jel dressings) for prolonged periods due to risk of hypothermia 2, 8
• Avoid routine use of topical antibiotics for uninfected wounds to prevent antimicrobial resistance 2

When to Refer to a Burn Center

• Burns involving the face, hands, feet, or genitals require specialized burn center treatment 2, 4
• Burns covering >10% TBSA in adults or >5% in children should be referred to a burn center 2, 4
• All full-thickness (third-degree) burns require medical attention 4
• Burns showing signs of infection or that are very painful 4