Skip to main content
SpringerLink
Log in

Current Treatment Recommendations for Topical Burn Therapy

  • Practical Therapeutics
  • Published:
Drugs Aims and scope Submit manuscript

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bentivegna P. Silver sulphadiazine: an adjunct to central line maintenance protocol. Correspondence. Critical Care Medicine 18: 120, 1990

    Article  PubMed  CAS  Google Scholar 

  • Bonder CC, Morris BJ, Wee T, Burke JF. The metabolic effects of 0.5% silver nitrate in the treatment of major burns in children. Journal of Pediatric Surgery 2: 22–31, 1967

    Article  Google Scholar 

  • Bowser-Wallace BH, Graves DB, Caldwell FT. An epidemiologic profile and trend analysis of wound flora in burned chidren: 7 years experience. Burns 11: 16–25, 1984

    Article  CAS  Google Scholar 

  • Burke JF, Quinby WC, Bondoc CC. Primary excision and grafting as routine therapy for the treatment of thermal burns in children. Surgical Clinics of North America 56: 477–494, 1976

    PubMed  CAS  Google Scholar 

  • Chicarelli ZN, Cuono CB, Heinrich JJ, Fichlander BC, Barese S. Selective aggressive burn excision for high mortality subgroups. Journal of Trauma 26: 18–25, 1986

    Article  Google Scholar 

  • Constable JD, Morris BJ, Burke JF. Absorption of silver nitrate from open wounds. Plastic and Reconstructive Surgery 39: 342–349, 1967

    Article  PubMed  CAS  Google Scholar 

  • Curreri WP. Burns. In Howard RJ & Simmons RL (Eds) Surgical infectious disease, pp. 873–881, Appleton Lange, Norwalk, 1988

    Google Scholar 

  • Deitch EA, Marino AA, Malakanok V, Albright JA. Silver nylon cloth: in vitro and in vivo evaluation of antimicrobial activity. Journal of Trauma 27: 301–304, 1987

    Article  PubMed  CAS  Google Scholar 

  • Demling RH. Burns. New England Journal of Medicine 313: 1389–1398, 1985

    Article  PubMed  CAS  Google Scholar 

  • Feller I, Tholen D, Cornell RG. Improvements in burn care, 1965–1979. Journal of the American Medical Association 244: 2074–2078, 1980

    Article  PubMed  CAS  Google Scholar 

  • Fox CL. Silver sulfadiazine: a new topical therapy for Pseudomonas in burns. Archives of Surgery 96: 184–188, 1968

    Article  PubMed  Google Scholar 

  • Fox CL, Monafo WW, Ayvazian VH, Skinner AM, Modak S, et al. Topical chemotherapy for burns using cerium salts and silver sulfadiazine. Surgery, Gynecology and Obstetrics 144: 668–672, 1977

    PubMed  Google Scholar 

  • Fuller FW, Engler PE. Leukopenia in non-specific burn patients receiving topical 1% silver sulfadiazine cream therapy: a survey. Journal of Burn Care and Rehabilitation 9: 606–609, 1988

    Article  PubMed  CAS  Google Scholar 

  • Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, et al. Early surgical excision versus conventional therapy in patients with 20–40 percent burns: a comparative study. American Journal of Surgery 144: 76–80, 1982

    Article  PubMed  CAS  Google Scholar 

  • Harrison HN, Bales H, Jacoby F. The behavior of mafenide acetate as a basis for its clinical use. Archives of Surgery 103: 449–453, 1971

    Article  PubMed  CAS  Google Scholar 

  • Harrison HN, Blackmore WP, Bales HW, Reeder W. The absorption of C14-labelled sulfamylon acetate through burned skin. 1. Experimental methods and initial observations. Journal of Trauma 12: 986–993, 1972

    Article  PubMed  CAS  Google Scholar 

  • Heggers JP, Robson MC, Herndon DN, Desai MH. The efficacy of nystatin combined with topical microbial agents in the treatment of burn wound sepsis. Journal of Burn Care and Rehabilitation 10: 508–511, 1989

    Article  PubMed  CAS  Google Scholar 

  • Hermans RP. Topical treatment of serious infections with special reference to the use of a mixture of silver sulfadiazine and cerium nitrate: two clinical studies. Burns 11: 59–62, 1984

    Article  CAS  Google Scholar 

  • Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, et al. A comparison of conservative versus early excision: therapies in severely burned patients. Annals of Surgery 209: 547–553, 1989

    Article  PubMed  CAS  Google Scholar 

  • Holder IA, Knoll CA, Wesselman J. Norfloxacin and silver norfloxacin as topical antimicrobial agents: results of in vitro susceptibility testing against bacteria and Candida sp. isolated from burn patients. Journal of Burn Care and Rehabilitation 7: 479–483, 1986

    Article  PubMed  CAS  Google Scholar 

  • Hunt JL, Sato RM. Early excision of full thickness hand and digit burns: factors affecting morbidity. Journal of Trauma 22: 414–419, 1982

    Article  PubMed  CAS  Google Scholar 

  • Hunt JL, Sato R, Heck EL, Baxter CR. A critical evaluation of povidone-iodine absorption in thermally injured patients. Journal of Trauma 20: 127–131, 1980

    Article  PubMed  CAS  Google Scholar 

  • Lawrence JC, Cason JS, Kidson A. Evaluation of phenoxetol-chlorhexidine cream as a prophylactic agent in burns. Lancet 1: 1037–1049, 1982

    Article  PubMed  CAS  Google Scholar 

  • Lindbergh RB, Moncrief JA, Mason AD. Control of experimental and clinical burn wound sepsis by topical application of Sulfamylon compounds. Annals of the New York Academy of Sciences 150: 950–972, 1968

    Article  Google Scholar 

  • McCauley RL, Linares HA, Pelligrini V, et al. In vitro toxicity of topical antimicrobial agents to human fibroblasts. Journal of Surgical Research 46: 267–274, 1989

    Article  PubMed  CAS  Google Scholar 

  • McManus AT, Denton CL, Mason AD. Topical chlorhexidine diphosphanilate (WP-973) in burn wound sepsis. Archives of Surgery 119: 206–211, 1984

    Article  PubMed  CAS  Google Scholar 

  • McManus AT, Moody EE, Mason AD. Bacterial motility: a component in experimental Pseudomonas aeruginosa burn wounsepsis. Burns 6: 235–239, 1980

    Article  Google Scholar 

  • Monafo WW, Mover CA. Effectiveness of dilute aqueous silver nitrate in the treatment of major burns. Archives of Surgery 91: 200–210, 1965

    Article  Google Scholar 

  • Moncrief JA. Topical therapy for control of bacteria in the burn wound. World Journal of Surgery 2: 151–165, 1978

    Article  PubMed  CAS  Google Scholar 

  • Moncrief JA, Lindbergh RB, Switzer WE, Pruitt BA. Use of topical antibacterial therapy in the treatment of the burn wound. Archives of Surgery 92: 558–565, 1966

    Article  PubMed  CAS  Google Scholar 

  • Moyer CA, Bretano L, Gravens DL, Margraf HW, Monafo WW. Treatment of large human burns with 0.5 percent silver nitrate solution. Archives of Surgery 90: 812–867, 1965

    Article  PubMed  CAS  Google Scholar 

  • Munster AM. Treatment of invasive Enterobacter cloacae burn wound sepsis with topical nitrofurazone. Journal of Trauma 24: 524–525, 1984

    Article  PubMed  CAS  Google Scholar 

  • Munster AM, Helvig E, Rowland S. Cerium nitrate-silver sulfadiazine cream in the treatment of burns: a prospective evaluation. Surgery 88: 658–660, 1980

    PubMed  CAS  Google Scholar 

  • Noble WC, Sommerville DA (Eds). Microbiology of human skin, Saunders, Philadelphia, 1974

  • Order SE, Moncrief JA. The burn wound, pp. 36–45, Charles C. Thomas, Springfield, Illinois, 1965

  • Peterson VM, Hansbrough JF, Wang XW, Zapata-Sirvent R, Boswick JA. Topical cerium nitrate cream prevents postburn immunosuppression. Journal of Trauma 25: 1039–1044, 1985

    Article  PubMed  CAS  Google Scholar 

  • Pruitt BA, Goodwin CW. Thermal injuries. In Davis JH (Ed.) Clinical surgery, pp. 2823–2904, Mosby, St Louis, 1987

    Google Scholar 

  • Pruitt BA, Lindbergh RB. Pseudomonas aeruginosa infections in burned patients. In Dogget RG (Ed.) Pseudomonas aeruginosa, pp. 339–366, Academic Press Inc., New York, 1979

    Google Scholar 

  • Pruitt BA, McManus AT. Opportunistic infections in severely burned patients. American Journal of Medicine XX: 146–154, 1984

    Article  Google Scholar 

  • Rath T, Meissl G. Induction of hyperthyroidism in burn patients treated topically with povidone-iodine. Burns 14: 320–322, 1988

    Article  CAS  Google Scholar 

  • Rode H, de Wet PM, Millar AJ, Cywes S. Bactericidal efficacy of mupirocin in multi-antibiotic resistant Staphylococcus aureus burn wound infection. Journal of Antimicrobial Chemotherapy 21: 589–595, 1988

    Article  PubMed  CAS  Google Scholar 

  • Schuck JM, Thorne LW, Cooper CG. Mafenide acetate solution dressings: an adjunct in burn wound care. Journal of Trauma 15: 595–599, 1975

    Article  Google Scholar 

  • Simmons RL, Ahrenholz DH. Infections of the skin and soft tissue. In Howard RJ & Simmons RL (Eds) Surgical infectious disease, pp. 337–441, Appleton Lange, Norwalk, 1988

    Google Scholar 

  • Smith-Choban P, Marshall WJ. Leukopenia secondary to silver sulfadiazine: frequency, characteristics and clinical consequences. American Surgeon 53: 515–517, 1987

    Google Scholar 

  • White MG, Asch MJ. Acid base effects of topical mafenide acetate in the burned patient. New England Journal of Medicine 284: 1281–1286, 1971

    Article  PubMed  CAS  Google Scholar 

  • Yurt RW, McManus AT, Mason AD, Pruitt BA. Increased susceptibility to infection related to extent of burn injury. Archives of Surgery 119: 183–188, 1984

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA

    William W. Monafo & Michael A. West

  2. Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA

    William W. Monafo & Michael A. West

Authors
  1. William W. Monafo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael A. West
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monafo, W.W., West, M.A. Current Treatment Recommendations for Topical Burn Therapy. Drugs 40, 364–373 (1990). https://doi.org/10.2165/00003495-199040030-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199040030-00004

Keywords

Search

Navigation