From the Guidelines
For burn patients, systemic antibiotic prophylaxis administered in the first 4–14 days significantly reduced all-cause mortality by nearly a half, and is therefore recommended. The decision to use antibiotics should be based on the presence of systemic inflammatory response syndrome (SIRS) and the severity of the burn 1. Topical antibiotics like silver sulfadiazine (Silvadene) cream, bacitracin, or mupirocin are commonly used to prevent infection, but their effectiveness is limited compared to systemic antibiotics in severe burns 1.
Some key points to consider when using antibiotics for burn treatment include:
- The role of an adequate source control, including surgical removal of contaminated material and areas of necrosis, and protection of the exposed lesion, is crucial in decreasing the infective risk 1.
- Systemic antibiotic prophylaxis was evaluated in three trials and there was no evidence of an effect on rates of burn wound infection, but it was associated with a significant reduction in pneumonia 1.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of skin and soft tissue infections is not recommended 1.
- For empirical coverage of MRSA in outpatients with skin and soft tissue infections, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline (doxycycline or minocycline), and linezolid 1.
It's essential to note that the use of antibiotics should be guided by the severity of the burn, the presence of SIRS, and the risk of infection, and should always be used in conjunction with proper wound care and management 1.
From the FDA Drug Label
Silver sulfadiazine cream, USP 1% is a topical antimicrobial drug indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second and third degree burns. The antibiotic for burns is silver sulfadiazine (TOP), as it is indicated for the prevention and treatment of wound sepsis in patients with second and third degree burns 2.
- Key points:
- Indicated for second and third degree burns
- Used as an adjunct for the prevention and treatment of wound sepsis
- Topical antimicrobial drug
From the Research
Antibiotics for Burn Treatment
- The primary goal of antibiotic treatment in burn patients is to control microbial colonization and prevent burn wound infection 3.
- Topical antimicrobial therapy is the most important component of wound care in hospitalized burn patients, with silver sulfadiazine being the most frequently used topical prophylactic agent 3.
- Systemic antibiotics are valuable in burn patients when properly used, but their use should be guided by principles such as identifying the responsible organism, choosing appropriate agents, and adjusting dosages based on serum concentrations 4.
Topical Antibiotics
- Silver sulfadiazine is effective against most burn pathogens and is relatively inexpensive, easy to apply, and well-tolerated by patients 3, 5.
- Mafenide acetate has superior eschar-penetrating characteristics, making it suitable for early treatment of burn wound sepsis, but its use should be limited due to systemic toxicity associated with prolonged or extensive use 3.
- Other topical agents, such as nitrofurazone or chlorhexidine preparations, may be useful in isolated clinical situations 3.
Systemic Antibiotics
- Systemic antibiotic prophylaxis is indicated in only a few clinical situations, including the immediate preoperative and postoperative periods associated with excision and autografting, and possibly in the early phases of burns in children 4.
- The choice of systemic antibiotic requires a thorough knowledge of side effects, toxicity, and potential benefit, and should be guided by the results of culture and sensitivity testing 4.
Current Guidelines and Research
- French guidelines for the use of antibiotics in burn patients have been developed based on a review of key points addressing the management of antibiotics for burn patients 6.
- A Cochrane review found that topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared with dressings or skin substitutes, but the evidence is limited by the volume and quality of the existing research 7.