Fusidic Acid Is Not Recommended for Burn Treatment
Topical antibiotic prophylaxis applied to burn wounds has no beneficial effects for reducing infection or mortality in burn patients. 1
Evidence Against Using Topical Antibiotics for Burns
- The most recent and highest quality evidence from a comprehensive review of 36 RCTs (2117 participants) found that topical antibiotic prophylaxis applied to burn wounds had no beneficial effects 1
- Systemic antibiotic prophylaxis significantly reduced mortality in burn patients, but topical antibiotics did not show similar benefits 1
- Silver sulfadiazine, a commonly used topical agent, was actually associated with increased burn wound infection compared to dressings/skin substitutes (OR = 1.87; 95% CI: 1.09 to 3.19) and significantly longer hospital stays (MD = 2.11 days; 95% CI: 1.93 to 2.28) 1
Recommended First Aid for Burns
Initial Management
- Thermal burns should be cooled immediately with clean running water 1
- Cool burns for 5-20 minutes 1
- Monitor children for hypothermia during cooling 1
- Over-the-counter pain medications (acetaminophen or NSAIDs) are recommended for burn pain 1
For Small Partial-Thickness Burns Managed at Home
- After cooling, apply one of the following to open burn wounds 1:
- Petrolatum
- Petrolatum-based ointment
- Honey
- Aloe vera
- Cover with a clean nonadherent dressing 1
For Burns Awaiting Professional Evaluation
- After cooling, loosely cover burns with intact skin or blisters with a clean cloth or nonadherent dry dressing 1
- Remove jewelry before swelling occurs 1
When to Seek Medical Care
- Burns involving the face, hands, feet, or genitals require specialized care 1
- Burns covering >10% body surface area in adults (>5% in children) need treatment at a burn center 1
- Any signs of inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth) require immediate emergency medical services 1
Why Fusidic Acid Is Not Recommended
While fusidic acid has been studied as a topical antibiotic for burns 2, 3, it is not specifically recommended in current guidelines for several reasons:
- The most recent high-quality evidence shows topical antibiotics in general provide no benefit for burn wound prophylaxis 1
- Burn wound infections are typically polymicrobial, requiring broader coverage than fusidic acid alone can provide 1
- Current guidelines recommend non-antimicrobial options like petrolatum, honey, or aloe vera for small burns 1
Common Pitfalls to Avoid
- Using topical antibiotics prophylactically on burns can lead to antimicrobial resistance 4
- Applying ice directly to burns (without cloth wrapping) can cause further tissue damage 1
- Delaying cooling of burns reduces the effectiveness of this intervention 1
- Failing to recognize when a burn requires professional medical care can lead to increased morbidity and mortality 1
For burn management, focus on proper cooling, appropriate dressings, pain control, and timely referral to specialized care rather than topical antibiotics like fusidic acid.