Is Polysporin (bacitracin + polymyxin B ± neomycin) more appropriate than fusidic acid (Fucidin) for a superficial small‑area burn?

Polysporin Is the Better Choice for Superficial Small Burns

For superficial small-area burns, use petrolatum-based antibiotic ointments like Polysporin (bacitracin + polymyxin B) rather than fusidic acid (Fucidin), which provides no proven benefit for burn wound prophylaxis and may contribute to antimicrobial resistance. 1, 2

Why Polysporin Is Recommended

• The American College of Surgeons explicitly recommends applying a thin layer of petrolatum-based antibiotic ointment (bacitracin, Polysporin, or triple-antibiotic ointment) directly to superficial burns. 1

• Petrolatum-based antibiotic ointments are listed among reasonable first-line options for small partial-thickness burns managed at home, alongside petrolatum alone, honey, or aloe vera with clean nonadherent dressings. 3, 1

• These agents optimize re-epithelialization for superficial burns while providing a moist wound environment. 4

Why Fusidic Acid (Fucidin) Should Be Avoided

• The World Health Organization recommends against using fusidic acid as a topical antibiotic for burns because it provides no benefit for burn wound prophylaxis and may contribute to antimicrobial resistance. 2

• Fusidic acid is not mentioned in any major burn management guidelines as an appropriate agent for burn care, unlike petrolatum-based antibiotics which have explicit recommendations. 3, 1, 2

• The WHO specifically recommends using non-antimicrobial options like petrolatum, honey, or aloe vera for small burns instead of agents like fusidic acid. 2

Proper Application Protocol

Initial wound preparation:

• Clean the burn with tap water, isotonic saline, or antiseptic solution before applying any medication. 3, 1
• Cool the burn with clean running water for 5-20 minutes (up to 39 minutes for burns <20% TBSA in adults or <10% in children) to limit tissue damage and reduce pain. 3, 1

Application technique:

• Apply a thin layer of Polysporin directly to the burn surface. 1
• Cover with a non-adherent dressing such as Xeroform (petrolatum-impregnated gauze), Mepitel (silicone-coated dressing), or Telfa. 3, 1
• Add a secondary foam or burn dressing to collect exudate. 3

Follow-up:

• Re-evaluate the dressing daily to assess healing progress and detect early signs of infection. 3, 1

Critical Pitfalls to Avoid

• Do not use topical antibiotics as first-line prophylaxis for all burns—they should be dedicated to infected wounds only. The Infectious Diseases Society of America states that routine topical antibiotic prophylaxis has no beneficial effects on reducing infection or mortality in burn patients based on 36 RCTs involving 2117 participants. 1, 2, 5

• Avoid silver sulfadiazine on superficial burns. It is associated with increased burn wound infection rates (OR 1.87; 95% CI 1.09-3.19) and longer hospital stays by an average of 2.11 days compared to alternative dressings. 3, 5

• Do not apply ice directly to burns, as this causes further tissue damage. 1

• Avoid butter, oil, or other home remedies. 1

When to Seek Specialized Care

Refer to a burn center or seek immediate medical attention for: 1, 2

• Burns involving the face, hands, feet, or genitalia
• Burns covering >10% body surface area in adults (>5% in children)
• Signs of infection (increased pain, redness, swelling, purulent discharge)
• Any signs of inhalation injury (facial burns, difficulty breathing, soot around nose/mouth)