Routine antibiotic prophylaxis of burn wounds in children not necessary


By Megan Rauscher

WESTPORT, CT (Reuters Health) – Routine antibiotic prophylaxis against group A beta-hemolytic streptococci (GAS) infection is not necessary in children with burns, according to Dr. Robert L. Sheridan and others at the Shriners Burn Institute in Boston.

"Historically, GAS burn wound infection has been a major source of morbidity and mortality in burn patients and has prompted the prophylactic administration of antibiotics to children with burns," they explain in The Journal of Trauma for August. "Wound monitoring, surveillance cultures, and early excision of deep wounds may have changed this."

The researchers reviewed their experience with 917 burned children. The 511 children admitted between 1992 and 1994 routinely received 72 hours of oral or intravenous penicillin (or, if allergic, oral erthromycin or intravenous clindamycin). Of the 406 children who were admitted between 1995 and 1997, only those with documented GAS infection received antibiotic prophylaxis. The two groups were matched for age and burn size.

The data showed, Dr. Sheridan told Reuters Health, that "when extensive deep burns undergo early excision and grafting and more superficial burns are treated with effective topical therapy and observation, the incidence of GAS burn wound infection is low and is not further reduced by prophylactic antibiotics."

When GAS burn infection does occur, it does so more commonly in children who are carriers of the organism at the time of injury, according to the researchers. They say this finding highlights the importance of screening for GAS infections at the time of admission, as well as daily monitoring of wounds for signs of evolving infections.

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