Burn Wound Infections Medication

Updated: Dec 17, 2019
  • Author: Jairo A Fonseca, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication

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. [40]

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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