What oral antibiotic is recommended for a superficial burn with signs of infection?

Oral Antibiotics for Superficial Burn Infections

For superficial burn wounds with signs of infection, dicloxacillin or cephalexin should be used as first-line oral antibiotic therapy, with clindamycin as an alternative for penicillin-allergic patients. 1, 2

First-Line Treatment Options

• Dicloxacillin (500 mg orally four times daily) for 7-10 days is recommended as a first-line treatment for superficial burn infections 1, 2
• Cephalexin (500 mg orally three times daily) for 7-10 days is an equally effective first-line option 1, 2
• These antibiotics target Gram-positive bacteria, particularly Staphylococcus aureus and streptococci, which are the most common pathogens in early burn wound infections 3, 1

Alternative Options for Penicillin Allergy or MRSA Concerns

• Clindamycin (300-450 mg orally three times daily) for 7-10 days is the preferred alternative for penicillin-allergic patients 2, 4
• Trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily) should be considered when MRSA is suspected 1, 2
• Doxycycline (100 mg orally twice daily) is another effective option for MRSA coverage 2

Treatment Approach Based on Infection Severity

• For mild to moderate infections in patients without recent antibiotic exposure, therapy targeting only aerobic Gram-positive cocci is sufficient 3, 1
• Burn wound infections are often polymicrobial, initially with Gram-positive bacteria from the patient's skin flora, but can become colonized with Gram-negative bacteria within a week 3
• Consider empiric therapy for community-acquired MRSA for patients at risk or who don't respond to first-line therapy 1

Duration of Treatment

• For mild superficial infections, antibiotic therapy should typically last 7-10 days 1, 2
• Continue antibiotics until resolution of infection signs but not through complete wound healing 3
• Reassess the wound within 48-72 hours to evaluate treatment response 1

Wound Care Considerations

• Proper wound cleansing and debridement of necrotic tissue are crucial adjuncts to antibiotic therapy 3, 1
• Topical antimicrobial agents may be used alongside oral antibiotics for superficial burns with signs of infection 5, 6
• Silver sulfadiazine remains the most frequently used topical prophylactic agent for burn wounds, though it may delay healing if used long-term on superficial burns 3, 7

Special Considerations

• Bacterial cultures should guide definitive antibiotic selection when available 3
• Systemic antibiotic prophylaxis is not recommended for uninfected burn wounds 3
• Switch to broader-spectrum antibiotics if there's no improvement after 48 hours of treatment 1
• Consider parenteral therapy for moderate to severe infections, at least initially 3, 1

When to Consider Referral

• Deep burns or those involving >10% total body surface area 5
• Signs of systemic infection or sepsis 3
• Failure to respond to appropriate oral antibiotic therapy 1
• Burns in high-risk locations (face, hands, feet, genitals, major joints) 3