Silvadene or??

[cheezwizz90]

At my burn center, we place new burns in silvadene dressings BID (or we have a protocol for silver nitrate soaks if I'm on-call, the burn isn't life-threatening and the attending isn't coming in until the morning) for the few days before they are grafted. Then we switch to xeroform. They keep in silvadene (SSD) for long term if they aren't getting grafted, then downgrade to xeroform and then perhaps plain bacitracin. I have read that the burn center at Mass General has long used silver nitrate soaks instead of SSD.

I started work at a new wound clinic that hardly sees many burns, but whenever we get one, the doctor says that there is "new research" that says silvadene causes terrible infections, is ineffective and it's hard/messy for patients to do at home ( I agree with the hard/messy part. It takes dedicated BID changes and SSD can macerate intact skin) and so he prefers to use just bacitracin and gauze. I was shocked to hear that and I can't find this research, nor have I heard of it. I have seen SSD heal many many burns plus it is antimicrobial. It would be sacrilege to forgo the SSD at my burn center. I can see infection setting in if the silvadene burn dressing isn't changed BID, but not otherwise. Plus, the benefit of SSD is that it cools down the burning sensations.

What topical do you all use in the acute phase of burns? What is best practice?

[zzbxdo]

We use and alternate ssd and sulfamylon on dirty burns pre surgical debridement. Our docs used follow the Wound clinic too but would treat the population much differently (chronic old nasty ulcers etc). I attended the western regional burn conference last November and there wasn't anything groundbreaking other than more uses in medical grade money.

[CraigB-RN, MSN, RN]

Definitely Bacitracin it pt is going to be taking care of at home. Most people don't clean the Silvidine off well enough when they do dressing changes. It's not really new research it's just that the Silvidine isn't supported in what is there. It's expensive also when Bacitracin cost spare change and does just as well1: Soroff HS, Sasvary DH. Collagenase ointment and polymyxin B sulfate/bacitracinspray versus silver sulfadiazine cream in partial-thickness burns: a pilot study.

J Burn Care Rehabil. 1994 Jan-Feb;15(1):13-7. PubMed PMID: 8150836.

2: Strock LL, Lee MM, Rutan RL, Desai MH, Robson MC, Herndon DN, Heggers JP.

Topical Bactroban (mupirocin): efficacy in treating burn wounds infected with

methicillin-resistant staphylococci. J Burn Care Rehabil. 1990

Sep-Oct;11(5):454-9. PubMed PMID: 2123203.

These are the two I had in my database, I'd have to do a more intensive search. I also remember an article from Journal of Clinical Derm but I can't seem to find it right now. The May 1999 edition of Burns I think had a comparison article.