Petrolatum-Based Antibiotic Ointment for Second-Degree Burns
For small partial-thickness (second-degree) burns being managed at home, it is recommended to apply a petrolatum-based antibiotic ointment such as triple antibiotic ointment (containing bacitracin, neomycin sulfate, and polymyxin B) after proper cooling of the burn. 1
Initial Management of Second-Degree Burns
- Immediately cool the burn with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1
- Remove any jewelry from the affected area before swelling occurs to prevent constriction and vascular compromise 2
- Monitor for signs of hypothermia in preadolescent children during cooling 1
- Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain management 1, 2
Appropriate Topical Treatment Options
- After cooling, apply a petrolatum-based antibiotic ointment such as triple antibiotic ointment (containing bacitracin, neomycin sulfate, and polymyxin B) 1, 3
- Triple antibiotic ointment is effective against the most common pathogens found in wounds and on the skin 3
- Research shows that triple antibiotic ointment has demonstrated lower infection rates compared to petrolatum alone 4
- In a porcine model of deep partial-thickness burns, triple antibiotic ointment enhanced reepithelialization and reduced scar depth compared to silver-based dressings 5
Application and Dressing
- Apply a thin layer of the petrolatum-based antibiotic ointment to the burn wound 5
- Cover with a clean, non-adherent dressing after application 1, 6
- Change the dressing approximately three times weekly 5
- Keep the burn area moist with the ointment to promote healing 5
When to Seek Medical Attention
- Second-degree burns involving the face, hands, feet, or genitalia require specialized care regardless of size 1, 7
- Burns covering >10% body surface area in adults (>5% in children) should be treated in a specialized burn center 1
- Seek immediate medical attention if there are signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 7
- Burns that will not heal within 2 weeks should be referred to a burn surgeon due to increased risk of infection and scarring 8
Common Pitfalls to Avoid
- Do not apply ice directly to burns as this can cause further tissue damage 2
- Do not apply butter, oil, or other home remedies to burns 2
- Do not break or pop blisters as this significantly increases infection risk 2, 6
- Do not delay seeking medical attention for burns in sensitive areas or those covering large surface areas 1
Specific Antibiotic Recommendations
- Triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B in a petrolatum base is effective for preventing infections in burn wounds 3, 4
- Bacitracin alone or in combination with other antibiotics has shown effectiveness in preventing wound infections 4
- Compounded preparations containing bacitracin, silver sulfadiazine, and other antibiotics have shown broad effectiveness against burn wound isolates 9