Topical antimicrobials in pediatric burn wound management

Burn trauma continues to injure an estimated 1 million children each year in the United States alone, with many more injuries suffered worldwide. Several decades ago, advances in acute burn wound management, including development of topical antimicrobials, dramatically improved outcomes in pediatric burn injuries. However, infection remains the leading cause of burn wound mortality. With increasing antibiotic resistance in many medical centers, precise selection of topical antimicrobial therapy has grown in importance for pediatric burn management. Effective choice and application of topical antimicrobials require correct classification of burn wounds, appropriate understanding of the process of burn wound sepsis, and accurate identification of pathogens for individual patients as well as for their surrounding environment. This article examines the current and evolving role of topical antimicrobials in pediatric burn wound management. Burn wound classification, the biologic process of burn wound sepsis, wound cultures with pathogen profiling, and evaluations of commonly used topical antimicrobials are reviewed. Newer biologically active occlusive (bio-occlusive) and hybrid products are examined in the context of topical antimicrobial therapy and their increasing role in pediatric burn wound management.