Oral Antibiotics for Burn Wounds
Routine oral antibiotic prophylaxis is NOT recommended for burn wounds, as systemic antibiotics do not reduce infection rates in non-surgical burn patients and increase the risk of selecting multidrug-resistant bacteria. 1, 2
When Oral Antibiotics Should NOT Be Used
Prophylactic oral antibiotics should be avoided in burn patients outside the perioperative period, as they provide no proven benefit for preventing burn wound infection and significantly increase antimicrobial resistance. 1, 2
Topical silver sulfadiazine should be avoided for superficial burns, as it is associated with increased burn wound infection rates (OR 1.87) and prolonged hospital stays (mean difference 2.11 days longer). 2, 3, 4
Non-absorbable oral antibiotics for selective decontamination significantly increased MRSA rates (RR 2.22) without reducing infection. 2, 4
When Oral Antibiotics ARE Indicated
For Confirmed Burn Wound Infections
When burn wound infection is documented by culture and clinical signs, oral antibiotics should be selected based on:
For methicillin-susceptible Staphylococcus aureus (MSSA):
- Dicloxacillin 500 mg four times daily (oral agent of choice) 1
- Cephalexin 500 mg four times daily (alternative for penicillin-allergic patients without immediate hypersensitivity) 1
- Clindamycin 300-450 mg three times daily 1
For methicillin-resistant Staphylococcus aureus (MRSA):
- Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily 1
- Doxycycline 100 mg twice daily 1
- Linezolid 600 mg twice daily (expensive, limited cross-resistance) 1
For mixed infections or Pseudomonas aeruginosa:
- Ciprofloxacin in combination with other agents for pandrug-resistant organisms 5
- Levofloxacin for moderate to severe infections 1
Critical Wound Care Principles
Clean wounds thoroughly with tap water, isotonic saline, or antiseptic solution before any treatment. 1, 2
Debride necrotic tissue as proper wound cleansing and debridement is crucial for healing in addition to antibiotic treatment. 2
Obtain wound cultures and base systemic antibiotic decisions on culture results if infection worsens despite topical therapy. 2
Seek surgical consultation for extensive necrosis, deep infection, or signs of systemic infection. 2
Special Clinical Scenarios
Perioperative prophylaxis: While perioperative systemic antibiotics reduced wound infections in surgical burn patients, they did not reduce mortality and should be limited to the surgical period only. 2, 6, 4
Severe burns with mechanical ventilation: Early systemic prophylaxis (particularly trimethoprim-sulfamethoxazole) significantly reduced all-cause mortality by nearly half and decreased pneumonia rates in severe burn patients requiring mechanical ventilation. 2, 6, 4
Elderly patients: Have delayed wound healing and increased infection susceptibility; use acetaminophen for pain management as it is effective and safe. 2
Common Pitfalls to Avoid
Do not use prolonged topical antibiotics as first-line treatment; reserve for documented infected wounds only. 1
Monitor distal perfusion when applying circular dressings to prevent tourniquet effect. 1, 2
Avoid external cooling devices for prolonged periods during transport to prevent hypothermia. 1
The benefit of long-term systemic antibiotic prophylaxis in the majority of burn patients is not evident and should be avoided. 6