The
pharmacotherapy of
burn care has evolved from the first topical
antibiotics instituted > 30 years ago. These have helped greatly to reduce the incidence of
burn wound sepsis, but a better understanding of the principles of
burn care has resulted in earlier
burn wound excision and complete coverage with autograft, cadaver skin, synthetic dressings, and amnion. This has markedly reduced septic complications and ameliorated the hypermetabolic response to
burn injury. The hypermetabolic response, which is mediated by hugely increased levels of circulating
catecholamines,
prostaglandins,
glucagon and
cortisol, causes profound skeletal muscle catabolism, immune deficiency, peripheral lipolysis, reduced bone mineralisation, reduced linear growth, and increased energy expenditure. Supportive
therapy and pharmacological manipulation, acutely and during rehabilitation, with
growth hormone,
insulin and related
proteins,
oxandrolone and
propranolol can ameliorate the hypermetabolic response, improving survival and long-term outcome. Despite judicious use of topical and systemic
antibiotics, opportunistic nosocomial bacterial resistance threatens to annul the improved survival of patients with severe
burns. Patterns of emerging resistance encountered in burn units need to be considered, in light of a decreasing
antibiotic armamentarium. A holistic approach to
pharmacotherapy of severely burned patients including current practice in antimicrobial control,
analgesia, sedation, and anxiety management is required. Current
therapy of frequently encountered problems, such as post-
burn pruritus, prophylaxis of
deep venous thrombosis and peptic ulceration, and pharmacological manipulation of inhalation injury in the burned patient is described. Current
pharmacotherapy to ameliorate psychosocial problems associated with
burns such as
acute stress disorder, depression and
post traumatic stress disorder are discussed. Better
analgesics, newer
antibiotics and immune stimulating drugs are required to reduce mortality and morbidity in large
burns.