Topical Antimicrobials Used in Burn Care
| Agent | Advantages | Disadvantages | Nursing Implications |
|---|
| Silver sulfadiazine 1% (Silvadene) | - Broad-spectrum antimicrobial
- Antifungal
- Nonstaining
- Relatively painless
- No systemic metabolic abnormalities
| - Less eschar penetration than mafenide acetate (Sulfamylon)
- Decreased granulocyte formation; transient leukopenia
- Macular rash
| Check for allergy to sulfa |
| Mafenide acetate (Sulfamylon) cream or solution | - Eschar penetration
- Effective with Pseudomonas
- Topical of choice for electrical burns
- Suitable for open or closed method of treatment (cream)
- Used for gram-negative organisms
| - Severe pain and burning sensation (lasts 30 min)
- Metabolic acidosis
- Carbonic anhydrase inhibitor
- Ineffective against fungi
- May cause hypersensitivity rash
| - Administer pretreatment analgesic
- Monitor for metabolic acidosis and hyperventilation
- Check for allergy to sulfa; observe for rash
|
| Silver nitrate | - Low cost
- Broad spectrum
- Effective with Candida
| - Continuous wet soaks
- Superficial penetration
- Black staining of sheets
- Stinging
- Electrolyte imbalances (low sodium, low chloride, low calcium, low potassium), alkalosis
| - Check serum electrolytes daily
- Rewet dressing to keep moist
|
| Petroleum-and mineral oil–based (e.g., Bacitracin, Neosporin, Polysporin) | - Bactericidal, gram-positive and gram-negative organisms
- Painless
- Prevents drying of wound
| Limited ability to penetrate eschar | Apply in thin layer (1 mm) Reapply as needed. |