Topical Antimicrobials in Burn Care

Abstract

Burn wounds disrupt the body’s primary defense against invasion and colonization by microorganisms. Topical antimicrobials are one component in burn wound care. These agents suppress microbial growth to advantage skin cells and wound healing. Topical antimicrobials can be divided into two superclasses: antiseptics and antibiotics. Herein we review the four main classes of topical antiseptics (emulsifiers, acids, oxidizers, and heavy metals) as well as antiseptic-impregnated dressings in current clinical use and address the mechanisms as well as the advantages and disadvantages of each antiseptic for burn wound management.

Antibiotic Delivery Strategies to Treat Skin Infections When Innate Antimicrobial Defense Fails

“…Compared to the broad array of antibiotics that are delivered systemically, the list of topical antibiotics is much smaller, including: bacitracin, neomycin, polymyxin, mupirocin, and fusidic agents. Antiseptics commonly used for topical treatment of wound infections can be divided into four broad classes: emulsifiers (chlorhexidine, octenidine, polyhexamethylene biguanide, benzalkonium salts), oxidizers (hydrogen peroxide, dilute hyperchlorite preparations, iodine compounds), acids (acetic acid, honey, boric acid), and heavy metals (silver compounds, bismuth compounds, copper, and mercury) [32,38]. Not all of these agents are commonly used for treatment of skin wounds, as some are used primarily to reduce microbial burden on the skin surface prophylactically (chlorhexidine, octenidine, povidone iodine), while others are often used for irrigation and wound cleansing capacities (chlorhexidine).…”

“…Not all of these agents are commonly used for treatment of skin wounds, as some are used primarily to reduce microbial burden on the skin surface prophylactically (chlorhexidine, octenidine, povidone iodine), while others are often used for irrigation and wound cleansing capacities (chlorhexidine). Below, we specifically discuss topical uses of silver ions and iodophor (iodine) compounds, as both have extensive clinical data describing their use in wound care [38].…”

“…Silver is the most commonly used topical antimicrobial in the United States [38]. Silver ions work by binding the peptidoglycans of bacterial cell membranes being taken up by the cell and interfering with a variety of cellular functions [39].…”

“…Commercially available products include liquid solutions of AgNO 3 , ointments of silver sulfadiazine (Silvadene, Pfizer, Inc), and a large array of impregnated dressings [40]. The AgNO 3 comes in solutions with concentrations varying from 0.5% to 50%, though 0.5% is the standard concentration [38]. Silver sulfadiazine cream, which was first introduced in the 1960s, is used to prevent bacterial colonization of wounds such as burns [41].…”

“…Silver sulfadiazine cream, which was first introduced in the 1960s, is used to prevent bacterial colonization of wounds such as burns [41]. This product is a combination of sulfadiazine (a sulfa antibiotic) and silver ions; the product typically is used in a 1% cream [38]. AgNO 3 and silver sulfadiazine both maintain moist environments that promote wound healing while also preventing the dressings from adhering to the wound and causing pain on application.…”