American Journal of Clinical Dermatology

, Volume 3, Issue 8, pp 529–534 | Cite as

Topical Treatment of Pediatric Patients with Burns

A Practical Guide
  • Tina L. PalmieriEmail author
  • David G. Greenhalgh
Therapy in Practice


Over 440 000 children receive medical attention for burn injuries each year in the US. Burn wound infections are a major source of morbidity and mortality in these patients. Infected wounds not only heal more slowly, but also may lead to systemic infections. The factors that contribute to wound complications are both the size and depth of the wound.

Burn depth is usually categorized into first-degree (superficial, involving only the epidermis), second-degree (partial thickness, involving both epidermis and dermis), and third-degree (full thickness, through the epidermis, dermis, and into fat). Burns that will not heal within 2 weeks are at least second-degree and should generally be referred to a burn surgeon for possible excision and grafting, due to the increased risk of infection and scarring.

The burn wound is dynamic. Proper treatment minimizes the extent of the burn injury, whereas improper treatment (lack of proper wound-care, edema formation, lack of resuscitation) may actually increase the size and/or depth of the wound. Topical antimicrobial agents have been shown to decrease wound-related infections and morbidity in burn wounds when used appropriately. The goal of topical antimicrobial therapy is to control microbial colonization, thus preventing development of invasive infections. A wide variety of agents are available for treatment of burn wounds, including ointments, creams, biological and nonbiological dressings. Topical antimicrobials of choice include bacitracin, neomycin, silver sulfadiazine and mafenide.


Bacitracin Topical Agent Silver Nitrate Solution Silver Sulfadiazine Thickness Burn 
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The authors have no conflicts of interest that are directly relevant to the content of this manuscript.


  1. 1.
    Center for Disease Control. 1990 Mortality Data. Atlanta (GA): Center for Disease Control, 1990Google Scholar
  2. 2.
    Yurt R.W., McManus A.T., Mason A.D., et al. Increased susceptibility to infection related to extent of burn injury. Arch Surg 1984; 119: 183–188PubMedCrossRefGoogle Scholar
  3. 3.
    Hunt J.L., Sato R.M. Early excision of full thickness hand and digit burns; factors affecting morbidity. J Trauma 1982; 22: 414–419PubMedCrossRefGoogle Scholar
  4. 4.
    Wolf S.E., Rose J.K., Desai M.H., et al. Mortality determinants in massive pediatric burns. Ann Surg 1997; 225: 554–569PubMedCrossRefGoogle Scholar
  5. 5.
    Herndon D.N., Barrow R.E., Rutan R.L., et al. A comparison of conservative versus early excision therapies in severely burned patients. Ann Surg 1989; 209: 547–552PubMedCrossRefGoogle Scholar
  6. 6.
    Sheridan R.T., editor. Advanced burn life support provider manual. Chicago (IL): American Burn Association, 2001: 13-23Google Scholar
  7. 7.
    Lund C., Browder N.C. The estimation of areas of burns. Surg Gynecol Obstet 1944; 79: 352–358Google Scholar
  8. 8.
    Jacobs M.R., Zanowiak P. Topical anti-infective products. In: Feldman E.G., editor. Handbook of nonprescriptive drugs. 9th ed. Washington, DC: American Pharmaceutical Association, 1990: 779–781Google Scholar
  9. 9.
    Taddonio T.E., Thomson P.D., Smith Jr D.J., et al. A survey of wound monitoring and topical antimicrobial therapy practices in the treatment of burn injury. J Burn Care Rehabil 1990; 11: 423–427PubMedCrossRefGoogle Scholar
  10. 10.
    Sheth K.V., Abdulatiff M., Al-Sedairy S. Effects of bacitracin on the human neutrophil oxidative respiratory burst and chemotaxis. Int J Immunopathol Pharmacol 1993; 6 (1): 43–49Google Scholar
  11. 11.
    Monafo W.W., West M.A. Current treatment recommendations for topical burn therapy. Drugs 1990; 40: 364–373PubMedCrossRefGoogle Scholar
  12. 12.
    Kaiser W., Von der Lieth H., Potel J., et al. Local application of silver sulfadiazine, cefsulodin and povidone iodine on burns in animals: an experimental study. Infection 1984; 12 (1): 31–35PubMedCrossRefGoogle Scholar
  13. 13.
    Lineaweaver W., McMorris S., Soucy D., et al. Cellular and bacterial toxicities of topical antimicrobials. Plast Reconstr Surg 1985; 75: 394–396PubMedCrossRefGoogle Scholar
  14. 14.
    Ward R.S., Saffle J.R. Topical agents in burn and wound care. Phys Ther 1995; 75: 526–538PubMedGoogle Scholar
  15. 15.
    Lee J.J., Marvin J.A., Heimbach D.M., et al. Use of 5% sulfamylon (mafenide) solution after excision and grafting of burns. J Burn Care Rehabil 1988; 9 (6): 602–605PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Shriners Hospitals for Children Northern California and Department of SurgerySacramentoUSA

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