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.