What are the recommended medications for treating tonsil burns?

Treatment of Tonsil Burns

For tonsil burns, immediately cool the affected area with cold water (15-25°C) and manage pain with oral acetaminophen or NSAIDs, followed by application of petrolatum-based ointments, honey, or aloe vera to promote healing. 1, 2

Immediate Management

• Remove any jewelry or constricting items from the neck area before swelling occurs to prevent vascular compromise 1, 2
• Cool the burn with clean running water at 15-25°C until pain is relieved, which helps reduce inflammation and tissue damage 1, 2
• Monitor for signs of airway compromise, including difficulty breathing, facial burns, singed nasal hairs, or soot around the nose or mouth, as these indicate potential inhalation injury requiring emergency medical services 1
• Avoid ice application directly to tissues, as this causes tissue ischemia and further damage 1, 2

Pain Management

Acetaminophen is the first-line treatment for pain associated with minor burns 3. For tonsil burns specifically:

• Administer over-the-counter oral analgesics such as acetaminophen or NSAIDs for pain relief 1, 2
• Consider multimodal analgesia combining both acetaminophen and NSAIDs if pain is significant, as this provides superior pain control 1, 2
• NSAIDs do not increase bleeding risk despite historical concerns, and multiple meta-analyses support their safety 1
• Avoid codeine, as it provides no benefit over acetaminophen alone and has a known adverse event profile including nausea and vomiting 1

For severe burns requiring hospitalization:

• Titrated intravenous opioids are the mainstay for severe burn pain, using short-acting agents that can be adjusted rapidly 4
• Intravenous ketamine provides significant opioid-sparing effects for severe burn-induced pain 4, 2

Topical Treatment After Cooling

Once the burn has been adequately cooled:

• Apply a thin layer of petrolatum (Vaseline) or petrolatum-based antibiotic ointment without sulfonamides (such as polymyxin B or bacitracin) to open burn wounds 1, 2
• Medical-grade honey or aloe vera gel are effective alternatives that promote healing and reduce pain 1, 2
• Cover the burn loosely with a clean, non-adherent dressing to protect the wound and reduce pain while avoiding heat entrapment 1, 2

When to Seek Emergency Care

Activate emergency medical services immediately if there are signs of:

• Inhalation injury (facial burns, difficulty breathing, singed nasal hairs, soot around nose/mouth) 1
• Burns involving the face, hands, feet, or genitals, as these may require surgical intervention to prevent permanent disability 1, 2
• Partial-thickness burns >10% body surface area in adults or >5% in children 1, 2
• Full-thickness burns of any size 2
• Circumferential burns requiring potential escharotomy 2

Antibiotic Considerations

• Prophylactic antibiotics are not indicated for most burn patients 3
• Perioperative antibiotics should be avoided in routine burn care, as there is convincing evidence of no beneficial impact on recovery except for possibly reduced fever 1
• Silver sulfadiazine is the standard topical antimicrobial treatment for partial-thickness burns when antimicrobial coverage is needed 3, 5

Common Pitfalls

• Do not delay analgesia for wound care procedures, as burn wound management requires adequate pain control 4
• Avoid prolonged cold exposure to large burns, as this can cause hypothermia and further tissue injury, especially in children 1, 2
• Do not leave blisters unroofed unnecessarily, as intact blisters improve healing and reduce pain 2, 6
• Do not undertreate pain due to unfounded concerns about opioid dependency, as there is no clear evidence that appropriate opioid use in acute burn pain increases likelihood of developing dependency 4