Use of systemic antibiotics in the burned patient.

A diagnosis of clinical sepsis is the primary indication for administration of systemic antibiotics. Choices of antibiotics for sepsis, where cultures are unavailable, requires a knowledge of current strains in the unit where the patient resides and coverage for both Staphylococcus aureus and Pseudomonas. Dosage requirements are increased in burned patients and serum antibiotic levels must be monitored for maximal effectiveness and minimal toxicity. Localized foci of infection must be identified and eradicated with regional antibiotic therapy or surgery when possible. Gram-negative pneumonia in the patient with an inhalation injury poses special difficulties in therapy. Resistance to antibiotics must be constantly guarded against and isolation procedures followed to avoid its propagation in the burn unit. Combination drug regimens and plasmid-directed therapy may in the future slow down the acquisition of further antibiotic resistance and lead to improved salvage of severely burned patients.