Version May 2024
| Antimicrobial agents | Clinical indications | Effectiveness | Contraindications | Adverse effects |
| Silver sulfadiazine (1% cream) with or without cerium | Small, medium, and large surface area burns | Decreased colonization of wounds Alleviates pain Broad spectrum No evidence to support improved wound healing or reduction in bacterial wound infections[3] | Burns near eyes Pregnancy Breastfeeding Newborns <2 months Allergic to sulfonamides Signs of reepithelialization | Skin hypersensitivity Neutropenia (usually transient) Leukopenia (usually transient) Methemoglobinemia |
| Silver containing dressings (eg, Acticoat, Aquacel Ag) | Small, medium, and large surface area burns | Stronger antimicrobial activity, longer duration of action than silver sulfadiazine, some evidence for reduced wound infection rates[3] | Burns near eyes Pregnancy Allergic to silver | Systemic silver uptake, temporary staining of the skin, argyrosis-argyria*[4,5] |
| Bacitracin ointment 500 units/gram | Small surface area burns Face Ears Perineum Graft sites Alternative if allergic to sulfonamides | Ease of application and of removal Painless Frequent dressing changes | Bacterial resistance Signs of reepithelialization | Yeast colonization Skin hypersensitivity |
| Combination antibiotic ointment (eg, bacitracin, neomycin, and polymyxin B) | Small surface area burns Face Ears Perineum Graft sites Alternative if allergic to sulfonamides | Ease of application and of removal Painless Frequent dressing changes | Bacterial resistance Allergic reaction Signs of reepithelialization | Yeast colonization Skin hypersensitivity Ototoxicity and nephrotoxicity with neomycin-containing ointments (eg, Neosporin) |
| Mupirocin ointment/cream 2% | Small, medium surface area burns Face Ears Nose Perineum Alternative if allergic to sulfonamides | Gram-positive coverage includes methicillin-resistant Staphylococcus aureus (MRSA) Ease of application and of removal Painless Frequent dressing changes | Bacterial resistance Allergic reaction Signs of reepithelialization | Yeast colonization Skin hypersensitivity |
| Mafenide (8.5% cream, 5% solution) | Ears Nose Dense bacterial proliferation | Excellent eschar penetration Penetrates cartilage Gram-negative coverage includes Pseudomonas | Burns >40% total body surface area Allergic to sulfonamides | Metabolic acidosis (inhibits carbonic anhydrase) Painful Inhibits epithelial regeneration |
| Chlorhexidine | Only superficial burns | Does not interfere with reepithelialization Can be used with silver sulfadiazine Generally used as a cleansing agent | Deep burns Caution in neonates – rare association with cutaneous burns | Skin hypersensitivity |
| Povidone-iodine | Small, medium surface area burns | Only when no other agent is available | Children under 2 years Pregnancy Breastfeeding Thyroid disorders Signs of reepithelialization | Cytotoxicity (toxic to fibroblasts, reduces cell proliferation) Painful Skin hypersensitivities Chemical burn Iodine toxicity Renal failure Acidosis Anaphylaxis |
| Acetic acid | Antiseptic, topical agent often used in a diluted form as an adjunct in the setting of Pseudomonas aeruginosa[6] | Gram-negative bacteria including P. aeruginosa[7] | Superficial burns have been described from misuse[8] | High concentrations inhibit epithelialization, inhibit PMNs and fibroblasts |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
