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; Check for allergy to sulfa; observe for rash
Silver nitrate	Lowcost 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.

Wound Coverings

Example	Advantages	Disadvantages	Nursing Implications
Biological Xenograph	Promotes healing of clean wound; relieves pain; readily available; reduces water and heat loss	Easily digested by wound collagenase; allergic reactions	Overlap edges slightly; trim away when skin underneath has healed
Homograft-cadaver skin	Reduces water and heat loss; relieves pain; used with antimicrobial mesh; may be left in place until rejection occurs	May harbor disease	Observe for signs of infection
Amnion	Relieves pain; reduces water and heat loss; has bacteriostatic properties	Limited shelf life; requires special preparation for use; may harbor diseases	Change cover dressing q48h; leave on wound until it sloughs
Biosynthetic (Temporary) Biobrane	Protects from microbial penetration; decreases pain; promotes healing in partial-thickness burn	Not effective for preparing a granulation bed	Must be secured to skin with sutures, closure straps, tape, or staples; wrap with gauze; after 48 hr, check for adherence; once adherence has occurred, may be left open to air; check for signs of infection
Biosynthetic (Semipermanent)Integra Artificial Skin	Postexcisional treatment of lifethreatening full or deep partialthickness burns when autograft not available	Infection rate lower than autograft	Maintain integrity of covering; 18-20 days before thin autograft applied. Avoid hydrotherapy; observe for infection.