Many different topical agents are used for burn care around the world. On this page, you will find some of the most frequently recommended agents. Please adhere to local protocols, if available.

Silver sulphadiazine cream (SSD) (Flammazine®)

This agent has a broad antibacterial spectrum, acting against both Staphylococcus aureus and Pseudomonas aeruginosa. The disadvantage of SSD is that a slough layer will form over the wound, making it difficult to assess burn depth. SSD cannot be used indefinitely.

Honey mixture

This agent is comprised of 1/3 honey and 2/3 ghee/vegetable oil/glycerin/water. It has antibacterial properties, acting against Staphylococcus aureus.

5% Acetic acid (diluted vinegar)

This agent acts against Pseudomonas. Acetic acid may be useful in resource deprived settings, since it is relatively inexpensive and widely available.

Povidone-iodine (Betadine®)

This agent is less suitable than SSD for initial treatment, as it has a lesser antibacterial effect on burn wounds. It can be a useful alternative later in the treatment, for example in the treatment of small facial burn wounds. Povidone-iodine acts against Staphylococcus aureus.

Silver nitrate solution (0.5% AgNO3)

This agent acts against Pseudomonas and can be used to treat hypergranulation.

Papaya

Papaya contains papain, which causes enzymatic debridement. This reduces necrosis and the formation of proud flesh (hypergranulation). It also has antibacterial properties.

Pineapple

Pineapple contains bromelain, which has the same properties as papain in papaya. In practice, papaya is used more often than pineapple, as papaya is more widely available and less expensive.

Fusidic acid (Fucidin®)

This agent is not suitable for use in the initial treatment of the burn wound, but it can be used in the secondary stage of treatment. Fusidic acid acts against Staphylococcus aureus. However, the bacteria develop resistance after approximately 1 week of use. Therefore another topical antibiotic should be used after 1-2 weeks, for example Mupirocin (Bactroban®).

Sodium hypochlorite solution in paraffin (Eusol)

This agent is used to remove slough from a ‘dirty’ or highly contaminated wound bed, and to induce granulation tissue formation. Eusol is frequently used for (neglected) deep dermal partial thickness burns of the scalp, to prevent colonization of the wound by commensal bacteria within the hair follicles.

Cerium nitrate silver sulphadiazine cream (Ce-SSD) (Flammacerium®)

This agent acts against Staphylococcus aureus and Pseudomonas aeruginosa and inactivates toxic products from the eschar. Ce-SSD is used to cover burns of >20% TBSA until surgery is performed. It is also used for the treatment of facial burns. It creates a dry ‘crust’ and reduces evaporative water loss from the burned surface area.

Mafenide acetate solution (Sulfamylon®)

This agent has a broad spectrum of antibacterial activity.

Enzyme alginogel (Flaminal®)

This agent has a broad spectrum of antibacterial activity and is easy to use. Enzyme alginogel is available in two forms: Flaminal Forte® and Flaminal Hydro®.

Flaminal Forte® is used for wounds with large amounts of exudate and Flaminal Hydro® is used for wounds with moderate to light exudate.

Mupirocin (Bactroban®)

This agent is not suitable for use during the initial treatment, but it can be used during the secondary stage of treatment. Mupirocin acts against gram-positive bacteria such as Staphylococcus aureus.

Tetracycline

Tetracycline is a broad spectrum antibiotic. It is a topical agent commonly used to prevent and treat skin infections.

Nitrofurazone (Furacin®)

This agent has a broad spectrum of antibacterial activity and is easy to use. However, it is not effective for Pseudomonas. Nitrofurazone is often used to cover a split skin graft after transplantation.

Hydrocortisone/oxytetracycline/ polymyxin B (Terra-Cotril)

Officialy, Terra-Cotril is an eye ointment. However, this agent also acts against Pseudomonas and reduces hypergranulation in burns. The ointment is not available in large volumes, as it is marketed as an eye ointment. It is therefore is not used on large surface areas.