Medscape is available in 5 Language Editions – Choose your Edition here.


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.


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.


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.

Contributor Information and Disclosures

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.


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.


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.

  1. Latenser BA, Miller SF, Bessey PQ, et al. National Burn Repository 2006: a ten-year review. J Burn Care Res. 2007 Sep-Oct. 28(5):635-58. [Medline].

  2. Gomez R, Murray CK, Hospenthal DR, Cancio LC, Renz EM, Holcomb JB, et al. Causes of mortality by autopsy findings of combat casualties and civilian patients admitted to a burn unit. J Am Coll Surg. 2009 Mar. 208 (3):348-54. [Medline].

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

  4. Keen EF 3rd, Robinson BJ, Hospenthal DR, et al. Prevalence of multidrug-resistant organisms recovered at a military burn center. Burns. September 2010. 36:819-25. [Medline].

  5. Albrecht MC, Griffith ME, Murray CK, Chung KK, Horvath EE, Ward JA. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg. October 2006. 203:546-50. [Medline].

  6. Horvath EE, Murray CK, Vaughan GM, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg. 2007 Jun. 245(6):978-85. [Medline]. [Full Text].

  7. Sarabahi S, Tiwari VK, Arora S, Capoor MR, Pandey A. Changing pattern of fungal infection in burn patients. Burns. 2012 Jun. 38(4):520-8. [Medline].

  8. Kasten KR, Makley AT, Kagan RJ. Update on the critical care management of severe burns. J Intensive Care Med. 2011 Jul-Aug. 26(4):223-36. [Medline].

  9. Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, et al. Burn wound healing and treatment: review and advancements. Crit Care. 2015 Jun 12. 19:243. [Medline].

  10. Keen EF 3rd, Robinson BJ, Hospenthal DR, et al. Incidence and bacteriology of burn infections at a military burn center. Burns. 2010 Jun. 36(4):461-8. [Medline].

  11. Kennedy P, Brammah S, Wills E. Burns, biofilm and a new appraisal of burn wound sepsis. Burns. 2010 Feb. 36(1):49-56. [Medline].

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

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

  14. American Burn Association. Burn Incidence and Treatment in the United States: 2016. Available at Accessed: 04/17/2016.

  15. Peck M, Pressman MA. The correlation between burn mortality rates from fire and flame and economic status of countries. Burns. 2013 Sep. 39 (6):1054-9. [Medline].

  16. Mistry RM, Pasisi L, Chong S, Stewart J, She RB. Socioeconomic deprivation and burns. Burns. 2010 May. 36(3):403-8. [Medline].

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

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

  19. Kaiser ML, Thompson DJ, Malinoski D, Lane C, Cinat ME. Epidemiology and risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus among burn patients. J Burn Care Res. 2011 May-Jun. 32(3):429-34. [Medline].

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

  21. Schultz L, Walker SA, Elligsen M, Walker SE, Simor A, Mubareka S, et al. Identification of predictors of early infection in acute burn patients. Burns. 2013 Nov. 39 (7):1355-66. [Medline].

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

  23. Rodriguez NA, Jeschke MG, Williams FN, Kamolz LP, Herndon DN. Nutrition in burns: Galveston contributions. JPEN J Parenter Enteral Nutr. 2011 Nov. 35(6):704-14. [Medline].

  24. Eljaiek R, Dubois MJ. Hypoalbuminemia in the first 24h of admission is associated with organ dysfunction in burned patients. Burns. 2013 Feb. 39 (1):113-8. [Medline].

  25. Lavrentieva A, Papadopoulou S, Kioumis J, Kaimakamis E, Bitzani M. PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment. Burns. 2012 May. 38(3):356-63. [Medline].

  26. Mann EA, Wood GL, Wade CE. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature. Burns. 2011 Jun. 37(4):549-58. [Medline].

  27. Uppal SK, Ram S, Kwatra B, Garg S, Gupta R. Comparative evaluation of surface swab and quantitative full thickness wound biopsy culture in burn patients. Burns. 2007 Jun. 33(4):460-3. [Medline].

  28. Ono S, Imai R, Ida Y, Shibata D, Komiya T, Matsumura H. Increased wound pH as an indicator of local wound infection in second degree burns. Burns. 2015 Jun. 41 (4):820-4. [Medline].

  29. Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M. Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ. 2010 Feb 15. 340:c241. [Medline]. [Full Text].

  30. Lundy JB, Chung KK, Pamplin JC, Ainsworth CR, Jeng JC, Friedman BC. Update on Severe Burn Management for the Intensivist. J Intensive Care Med. 2015 Jun 24. [Medline].

  31. Sevgi M, Toklu A, Vecchio D, Hamblin MR. Topical antimicrobials for burn infections - an update. Recent Pat Antiinfect Drug Discov. 2013 Dec. 8 (3):161-97. [Medline].

  32. Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, Solà I, Bonfill Cosp X. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013 Jun 6. 6:CD008738. [Medline].

  33. Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, et al. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One. 2014. 9 (4):e95042. [Medline].

  34. D'Avignon LC, Hogan BK, Murray CK, Loo FL, Hospenthal DR, Cancio LC, et al. Contribution of bacterial and viral infections to attributable mortality in patients with severe burns: an autopsy series. Burns. 2010 Sep. 36 (6):773-9. [Medline].

  35. Azzopardi EA, Boyce DE, Thomas DW, Dickson WA. Colistin in burn intensive care: back to the future?. Burns. 2013 Feb. 39 (1):7-15. [Medline].

  36. Chong SJ, Ahmed S, Tay JM, Song C, Tan TT. 5 year analysis of bacteriology culture in a tropical burns ICU. Burns. 2011 Dec. 37(8):1349-53. [Medline].

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

  38. Breederveld RS, Tuinebreijer WE. Recombinant human growth hormone for treating burns and donor sites. Cochrane Database Syst Rev. 2014 Sep 15. 9:CD008990. [Medline].

  39. Wolf SE. Nutrition and metabolism in burns: state of the science, 2007. J Burn Care Res. 2007 Jul-Aug. 28(4):572-6. [Medline].

  40. Vicic VK, Radman M, Kovacic V. Early initiation of enteral nutrition improves outcomes in burn disease. Asia Pac J Clin Nutr. 2013. 22 (4):543-7. [Medline].

  41. Abdullahi A, Jeschke MG. Nutrition and anabolic pharmacotherapies in the care of burn patients. Nutr Clin Pract. 2014 Oct. 29 (5):621-30. [Medline].

  42. Melinyshyn A, Callum J, Jeschke MC, Cartotto R. Albumin supplementation for hypoalbuminemia following burns: unnecessary and costly!. J Burn Care Res. 2013 Jan-Feb. 34 (1):8-17. [Medline].

  43. Lin JJ, Chung XJ, Yang CY, Lau HL. A meta-analysis of trials using the intention to treat principle for glutamine supplementation in critically ill patients with burn. Burns. 2013 Jun. 39 (4):565-70. [Medline].

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

  45. Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns. 2006 Mar. 32(2):145-50. [Medline].

  46. Ciofi Silva CL, Rossi LA, Canini SR, Gonçalves N, Furuya RK. Site of catheter insertion in burn patients and infection: a systematic review. Burns. 2014 May. 40 (3):365-73. [Medline].

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.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.