Burn Wound Infections Medication

  • Author: Clinton Murray, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 24, 2011
 

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.

Antifungal agents may also be used. However, pathogen identification is necessary in order 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.

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Silver sulfadiazine (Silvadene, SSD, SSD-AF, Thermazene)

 

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

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Silver nitrate

 

Coagulates cellular protein and removes granulation tissue. It exhibits activity against gram-positive bacteria, gram-negative bacteria, and Candida 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.

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Mafenide (Sulfamylon)

 

Topical sulfonamide. Diffuses freely into the eschar and is highly effective against gram-negative organisms, including Pseudomonas species.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Duane R Hospenthal, MD, PhD  Chief, Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center; Professor of Medicine, Uniformed Services University of the Health Sciences

Duane R Hospenthal, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, and Medical Mycology Society of the Americas

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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  2. Pidcoke HF, Wade CE, Wolf SE. Insulin and the burned patient. Crit Care Med. Sep 2007;35(9 Suppl):S524-30. [Medline].

  3. Horvath EE, Murray CK, Vaughan GM, Chung KK, Hospenthal DR, Wade CE, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg. Jun 2007;245(6):978-85. [Medline].

  4. Murray CK, Hoffmaster RM, Schmit DR, Hospenthal DR, Ward JA, Cancio LC, et al. Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients. Arch Surg. Jul 2007;142(7):639-42. [Medline].

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  8. Albrecht MC, Griffith ME, Murray CK, Chung KK, Horvath EE, Ward JA, et al. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg. Oct 2006;203(4):546-50. [Medline].

  9. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. Apr 2006;19(2):403-34. [Medline].

  10. Esselman PC. Burn rehabilitation: an overview. Arch Phys Med Rehabil. Dec 2007;88(12 Suppl 2):S3-6. [Medline].

  11. Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. Nov-Dec 2007;28(6):776-90. [Medline].

  12. Mayhall CG. The epidemiology of burn wound infections: then and now. Clin Infect Dis. Aug 15 2003;37(4):543-50. [Medline].

  13. Regules JA, Carlson MD, Wolf SE, Murray CK. Analysis of anaerobic blood cultures in burned patients. Burns. Aug 2007;33(5):561-4. [Medline].

  14. Regules JA, Glasser JS, Wolf SE, Hospenthal DR, Murray CK. Endocarditis in burn patients: Clinical and diagnostic considerations. Burns. Oct 26 2007;[Medline].

  15. Schofield CM, Murray CK, Horvath EE, Cancio LC, Kim SH, Wolf SE, et al. Correlation of culture with histopathology in fungal burn wound colonization and infection. Burns. May 2007;33(3):341-6. [Medline].

  16. Shankar R, Melstrom KA Jr, Gamelli RL. Inflammation and sepsis: past, present, and the future. J Burn Care Res. Jul-Aug 2007;28(4):566-71. [Medline].

 
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