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Burn Wound Infections Medication

  • Author: Jairo A Fonseca, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: May 25, 2016
 

Medication Summary

The goals of antimicrobial therapy are to treat an underlying infection, to reduce morbidity, and to prevent mortality. Topical therapy is often applied to prevent infection and to treat ongoing infections or used as an adjunct to surgical treatment and systemic antibiotics. Systemic antimicrobial agents should be directed at the underlying pathogen recovered from culture or determined empirically from the local burn unit’s antibiogram while culture results are pending. If carbapenem resistance is confirmed for an isolated gram-negative bacteria, colistin should be considered.[35]

Antifungal agents may also be used; however, pathogen identification is necessary to determine the ideal antifungal agent, as amphotericin B is not active against all fungal infections.

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Antibacterial, Topical

Class Summary

Topical therapy is typically applied to prevent infection and to treat infection when adequate surgical management is not possible.

Chlorhexidine gluconate (Hibiclens, Hibistat, Tegaderm CHG Dressing)

 

Effective, safe, and reliable topical wash. Polybiguanide with bactericidal activity; usually supplied as a gluconate salt. At physiologic pH, the salt dissociates to a cation that binds to negatively charged bacterial cell walls and extramicrobial complex, causing bacteriostatic and bactericidal effects. Active against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast.

Commercially available central venous catheters impregnated with chlorhexidine and silver sulfadiazine are available.

Silver sulfadiazine (Silvadene, SSD, Thermazene)

 

Silver sulfadiazine is useful in the prevention of infections from second- or third-degree burns. It has bactericidal activity against many gram-positive and gram-negative bacteria, including yeast. It has poor eschar penetration.

Silver nitrate

 

Silver nitrate coagulates cellular protein and removes granulation tissue. It exhibits activity against gram-positive bacteria, gram-negative bacteria, and candidal species. The major drawbacks are that it has poor penetration of eschar, requires the use of occlusive dressings, and turns black upon contact with tissues.

Mafenide (Sulfamylon)

 

Mafenide is a topical sulfonamide. Through competitive inhibition of para-aminobenzoic acid, interferes with bacterial folic acid synthesis. It diffuses freely into the eschar and is highly effective against gram-negative organisms, including pseudomonal species.

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Vaccine, Inactivated (Bacterial)

Class Summary

These agents are used for tetanus immunization. A booster injection against tetanus in previously immunized individuals is recommended to prevent this potentially lethal syndrome.

Tetanus toxoid

 

Tetanus immune globulin (TIG) is used for passive immunization of any person with a wound that may be contaminated with tetanus spores. Tetanus toxoid is used to induce active immunity against tetanus in selected patients. Burns are extremely tetanus-prone wounds. All burn patients with an incomplete immunization history should receive a dosage of tetanus toxoid (Td for adults or children >7 y, DTP or TD for children < 7 y). Children with up-to-date primary immunization series are considered to be up-to-date for tetanus immunization status. If the patient has a history of complete immunization and the last immunization with absorbed tetanus toxoid is within the last 5 years, further immunization is not required. If the history of tetanus immunization is unknown, both Td and TIG should be administered.

Tetanus immune globulin (HyperTET S/D)

 

Used for passive immunization of any person with a wound that may be contaminated with tetanus spores.

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Contributor Information and Disclosures
Author

Jairo A Fonseca, MD Postdoctoral Fellow, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine

Jairo A Fonseca, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Coauthor(s)

Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH Adjunct Professor of Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio

Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, Medical Mycological Society of the Americas, Armed Forces Infectious Diseases Society, International Society for Human and Animal Mycology, American College of Physicians, American Society for Microbiology, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Fred A Lopez, MD Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Louisiana State Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Clinton Murray, MD Program Director, Infectious Disease Fellowship, San Antonio Uniformed Services Health Education Consortium

Clinton Murray, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Second-degree burns often are red, wet, and very painful. Their depth, ability to heal, and tendency to result in hypertrophic scar formation vary enormously.
 
 
 
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