Current Treatment Recommendations for Topical Burn Therapy

Abstract

Infections in burn patients continue to be the primary source of morbidity and mortality. Topical antimicrobial therapy remains the single most important component of wound care in hospitalised burn patients. The goal of prophylactic topical antimicrobial therapy is to control microbial colonisation and prevent burn wound infection. In selected clinical circumstances topical agents may be used to treat incipient or early burn wound infections. At the present time silver sulfadiazine is the most frequently used topical prophylactic agent; it is relatively inexpensive, easy to apply, well tolerated by patients, and has good activity against most burn pathogens. In patients with large burns the addition of cerium nitrate to silver sulfadiazine may improve bacterial control. Mafenide acetate has superior eschar-penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis. However, the duration and area of mafenide application must be limited because of systemic toxicity associated with prolonged or extensive use. Other agents, such as nitrofurazone or chlorhexidine preparations, may be useful in isolated clinical situations. The undesirable side effects of silver nitrate solution limit its use by most clinicians at the present time.

Burn Wound Infections

“…Several studies have demonstrated the role of topical antimicrobials in decreasing morbidity and mortality in patients with major burn injuries (partial-or full-thickness skin involvement), particularly before early excision (189,298,307). A recent study conducted by the U.S. Army Burn Center compared the levels of mortality of adult patients according to age and burn size before (1950 to 1963) and after (1964 to 1968) the introduction of mafenide acetate topical antibiotic therapy (62).…”

“…Widespread application of an effective topical antimicrobial agent substantially reduces the microbial load on the open burn wound surface and reduces the risk of infection (189,298,307). By controlling infection, effective topical antimicrobial therapy decreases the conversion of partial-thickness to fullthickness wounds, but its use is adjunctive to early excision therapy.…”

Silver-Impregnated Dressings for Sternotomy Incisions to Prevent Surgical Site Infections in Children

“…12,13,18,19 Silver-containing dressings have been marketed as bactericidal against a large number of gram-positive and gram-negative organisms for infants and children. 13 The results in the reduction of wound infections are mixed.…”

The Use and Effects of Silver Nitrate in Dentistry

“…In the studies done in vitro, the efficiency of silver sulphadiazine against Candida albicans was demonstrated. [6] IV.…”

“…Silver chloride is photochemically activated by ultraviolet light and forms the colloidal pieces of metalic silver. The pieces occuring are seen as black and penetrates the epidermis [6].…”