Antibiotic Recommendations for Infected Burns

Initial Assessment and Antibiotic Selection

For hospitalized patients with infected burns, the Infectious Diseases Society of America recommends intravenous vancomycin, linezolid, daptomycin, or clindamycin as empiric therapy for MRSA coverage, along with broad-spectrum antibiotics for gram-negative coverage pending culture results 1, 2
The Infectious Diseases Society of America suggests that empirical therapy for MRSA should be considered pending culture data for hospitalized patients with infected burns (classified as complicated skin and soft tissue infections) 3, 4, 5
Recommended MRSA coverage options include intravenous vancomycin (15-20 mg/kg/dose every 8-12 hours) 5, 2
Oral or IV linezolid (600 mg twice daily) is recommended for MRSA coverage 5, 2
Daptomycin (4 mg/kg/dose IV once daily) is an option for MRSA coverage 5, 2
Clindamycin (600 mg IV or PO 3 times a day) is an option if local resistance rates are low 5, 2
For gram-negative coverage in burn infections, piperacillin-tazobactam or ampicillin-sulbactam are recommended for broad-spectrum coverage 6

For hospitalized children with infected burns, the Infectious Diseases Society of America recommends vancomycin as first-line therapy (15 mg/kg/dose IV every 6 hours) 3, 5
Clindamycin (10-13 mg/kg/dose IV every 6-8 hours) is an option for children if local clindamycin resistance rates are low (<10%) 3, 5
Linezolid (10 mg/kg/dose PO/IV every 8 hours for children <12 years; 600 mg twice daily for children >12 years) is recommended for children 3, 5
Tetracyclines should not be used in children <8 years of age 3, 5

The Infectious Diseases Society of America recommends that the duration of therapy for infected burns typically ranges from 7-14 days, based on clinical response 2
Cultures should be obtained from infected burn wounds before starting antibiotics to guide targeted therapy 3, 5
Antibiotic therapy should be de-escalated based on culture and sensitivity results 7

The Infectious Diseases Society of America recommends keeping draining wounds covered with clean, dry bandages 2
Good personal hygiene with regular bathing and hand cleaning is essential 2
Avoid reusing or sharing personal items that have contacted infected skin 2
Focus environmental cleaning on high-touch surfaces 2

The Infectious Diseases Society of America advises against unnecessary antibiotic prophylaxis for uninfected burns, as this may lead to resistant organisms 7
Rifampin should not be used as a single agent or as adjunctive therapy for burn wound infections 4
Burn patients may have altered pharmacokinetics requiring dose adjustments 7
Systemic antibiotics should not be relied upon solely for treating burn wound infections; appropriate wound care and surgical debridement are essential components of treatment 7