What oral antibiotic is recommended for treating burns?

Oral Antibiotics for Burns

Routine systemic antibiotic prophylaxis is not recommended for burn patients unless there is evidence of infection. 1, 2

Initial Management of Burns

Non-Pharmacological Management (First Priority)

• Immediately cool the burn with clean running water for 5-20 minutes to limit burn progression and reduce pain 3
• Clean the wound with tap water, isotonic saline, or antiseptic solution before applying dressings 4
• Remove jewelry before swelling occurs to prevent vascular compromise 3
• For pain management, consider over-the-counter medications like acetaminophen or NSAIDs 3

Wound Care

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera to small partial-thickness burns 3
• Cover with a clean non-adherent dressing 3
• Topical antibiotics should be reserved for infected wounds only, not used as first-line treatment 2, 4

When Oral Antibiotics Are Indicated

For Infected Burns

• When infection is confirmed (not just colonization), oral antibiotics should be selected based on bacterial cultures 2
• For skin and soft tissue infections likely due to Staphylococcus aureus, recommended oral options include:
  • Dicloxacillin, cefalexin, clindamycin, doxycycline, or sulfamethoxazole-trimethoprim 3
• For MRSA infections or if highly suspected:
  • Clindamycin, doxycycline, or sulfamethoxazole-trimethoprim 3
• For non-purulent skin and soft tissue infections:
  • Phenoxymethylpenicillin (penicillin V), clindamycin, or cefalexin 3

Special Situations

• For animal bites with burns:
  • Amoxicillin-clavulanic acid is the preferred oral option 3
• For human bites with burns:
  • Amoxicillin-clavulanic acid is recommended 3
• For diabetic patients with infected burn wounds:
  • Mild infections: Dicloxacillin, clindamycin, cefalexin, levofloxacin, amoxicillin-clavulanic acid, or doxycycline 3
  • For suspected MRSA: Sulfamethoxazole-trimethoprim 3

When to Seek Medical Attention

• Burns involving the face, hands, feet, or genitals require immediate medical attention 3
• All full-thickness burns require medical attention 3
• Burns covering >10% body surface area in adults or >5% in children require medical attention 3
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) require immediate medical attention 3

Common Pitfalls to Avoid

• Administering systemic antibiotic prophylaxis routinely to burn patients without evidence of infection, which increases the risk of developing multidrug-resistant bacteria 3, 1
• Prolonged use of silver sulfadiazine on superficial burns, which may delay healing 2
• Failure to distinguish between colonization and actual infection in burn wounds 1
• Inadequate wound care, including failure to clean and debride wounds properly 1
• Not adjusting antibiotic dosages based on the altered pharmacokinetics in burn patients 5, 6

Monitoring and Follow-up

• Regular reassessment of wounds is necessary, with dressings ideally evaluated daily 2
• Obtain bacterial cultures when infection is suspected to guide appropriate antibiotic selection 2
• Monitor for signs of systemic infection requiring more aggressive antibiotic therapy 7