Use Of Topical Antimicrobials Research Articles

Comprehensive developmental investigation on simvastatin enriched bioactive film forming spray using the quality by design paradigm: a prospective strategy for improved wound healing

The use of topical antimicrobials in wound healing presents challenges like risk of drug resistance and toxicity to local tissue. Simvastatin (SIM), a lipid-lowering agent which reduces the risk of cardiovascular events, is repurposed for its pleiotropic effect in wound healing. A bioactive bioadhesive polymer-based film forming spray (FFS) formulation of SIM was designed using chitosan, collagen, hyaluronic acid and optimised by employing the DoE approach. Optimised formulation demonstrated moderate viscosity (12.5 ± 0.3 cP), rapid film formation (231 ± 5.6 s), flexibility, tensile strength and sustained drug release (T80 – time for 80% drug release − 9.05 ± 0.7 h). Scanning electron microscopy (SEM) verified uniformly dispersed drug within the composite polymer matrix. SIM FFS demonstrated antimicrobial activity against gram positive and gram negative bacteria. In vivo excision wound model studies in mice affirmed the beneficent role of bioactive polymers and the efficacy of SIM FFS in wound contraction and closure, tissue remodelling and re-epithelization in comparison to standard antimicrobial preparation. Cytokines TNF- alpha, IL-6 were downregulated and IL-10 was upregulated. Biochemical markers; hydroxyproline, hexosamine and histopathology were consistent with wound contraction observed. This is an exploratory effort in repurposing SIM for wound healing in a novel dosage form, underscoring its potential as an alternative to conventional topical antimicrobials.

Quantifying topical antimicrobial use before and during participation in an antimicrobial stewardship programme in Dutch companion animal clinics.

The emergence of bacterial strains resistant to topical antimicrobials in both human and veterinary medicine has raised concerns over retaining the efficacy of these preparations. Yet, little information is available regarding the use of topical antimicrobials in either sector for planning targeted interventions. This study aims to quantify the use of topical antimicrobials in 44 Dutch companion animal clinics before and during their participation in an antimicrobial stewardship programme (ASP), to explore the effect of the intervention on topical antimicrobial use (AMU). Hence, prescription and clinic animal population data, collected from July 2012 until June 2018 were used. Specifically, the period from July 2012 until June 2015 was defined as pre-intervention period, whereas clinics started to participate in the ASP from March 2016 onwards. As quantification metric, the Defined Daily Dose for Animals (DDDA) was used and a mixed effect times series model with auto-regression was applied to monthly topical AMU data. The intervention effect was modelled using a step function with a change in (linear) time trend and clinic characteristics, as potential determinants of topical AMU, were assessed using a multivariable regression model. A seasonal pattern was identified, in the pre-intervention period, where topical AMU was highest in July-August and lowest in February-March. In addition, total topical AMU appeared to significantly decrease over time in the pre-intervention period and the proportion of dogs in the clinic was positively associated with topical AMU. The intervention effect was significant only for second line and for skin product AMU. This study demonstrates that during participation in an ASP, second line and skin product AMU decreased in Dutch companion animal clinics. Additionally, this study demonstrates the existence of a seasonal effect and a decrease in topical AMU over time already before introduction of a targeted intervention.

Retrospective Analysis of the Real-World Use of Topical Antimicrobials in the Paediatric Population with Impetigo in Italy: Focus on the Role of Ozenoxacin 1% Cream.

Using electronic data from a large population-based network of Family Paediatricians (Pedianet), we aimed to describe the use of topical antimicrobials, including ozenoxacin 1% cream, in impetigo in children in Italy. We included 2929 children aged 6 months-14 years from 2016 to 2019 with at least one episode of impetigo treated with topical antimicrobials. Overall, 3051 cases of impetigo were included in the analysis. Treatment started in most cases on the same day as the impetigo diagnosis and lasted around eight days. In about 8% of the cases, a systemic antibiotic was prescribed after the topical antimicrobial, usually after 4-14 days. In this study, ozenoxacin was used in 8% of the cases. Treatment duration was significantly shorter for patients prescribed ozenoxacin compared to the whole study population (median of six vs. seven days, respectively). In contrast, the rate of treatment failure was similar. Very few adverse reactions were identified.

Guidelines of care for the management of atopic dermatitis in adults with topical therapies

New evidence has emerged since the 2014 guidelines that further informs the management of atopic dermatitis (AD) with topical therapies. These guidelines update the 2014 recommendations for management of AD with topical therapies. To provide evidence-based recommendations related to management of AD in adults using topical treatments. A multidisciplinary workgroup conducted a systematic review and applied the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach for assessing the certainty of evidence and formulating and grading recommendations. The workgroup developed 12 recommendations on the management of AD in adults with topical therapies, including nonprescription agents and prescription topical corticosteroids (TCS), calcineurin inhibitors (TCIs), Janus kinase (JAK) inhibitors, phosphodiesterase-4 inhibitors (PDE-4), antimicrobials, and antihistamines. The pragmatic decision to limit the literature review to English-language randomized trials may have excluded data published in other languages and relevant long-term follow-up data. Strong recommendations are made for the use of moisturizers, TCIs, TCS, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.

Executive summary: American Academy of Dermatology guidelines of care for the management of atopic dermatitis in adults with topical therapies

These guidelines update the 2014 recommendations for management of atopic dermatitis in adults with topical therapies. A multidisciplinary workgroup employed best practices for guideline development, including a systematic review of the evidence and application of the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading recommendations. The evidence on atopic dermatitis treatment supported strong recommendations for the use of nonprescription moisturizers, topical calcineurin inhibitors, topical corticosteroids, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.

The financial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States.

Atopic dermatitis (AD) is associated with elevated financial costs, including out-of-pocket (OOP) expenses. Yet, the full burden of OOP expenses in children with AD is poorly understood. We sought to characterise categories, impact, and associations of caregiver-reported OOP AD healthcare expenses for US children. An online survey was administered to National Eczema Association members (N=113502). Inclusion criteria (US resident; respondent age ≥18; self or caregiver report of AD diagnosis) was met by 77.3% (1118/1447) of those who completed the questionnaire. Caregivers of children (<18years) with AD reported increased healthcare provider (HCP) visits, comorbid food allergy, cutaneous infections, and topical antimicrobial use (p<0.005 for all), and increased OOP expenses for hospitalisation, emergency room visits, emollients, hygiene/bathing products, childcare, and specialised cleaning products, and clothing/bedding (p<0.05 for all) compared to adults with AD. Children with AD had increased median total yearly OOP expenditures ($860 vs. $500, p=0.002) and were more likely to spend ≥$1000 OOP per year (48.9% vs. 40.0%, p=0.03). In children, yearly OOP expenses ≥$1000 were associated with increased AD severity, flares, HCP visits, prescription polypharmacy, and step-up therapy use (p<0.005 for all) compared with adults. Predictors of harmful financial impact among children included black race (adjusted OR [95% confidence interval]: 3.86 [1.66-8.98] p=0.002) and ≥$1000 annual OOP expenditures (6.98 [3.46-14.08], p<0.0001). Children with AD have unique and increased OOP expenses that are associated with significant disease burden. Strategies are needed to reduce OOP costs and improve clinical outcomes in children with AD.

The Use of Topical Antibiotics Based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data in 2017

The national action plan on antimicrobial resistance (AMR) in Japan emphasizes the importance of understanding antimicrobial use (AMU). Some studies have been conducted on oral and parenteral AMU in Japan. However, there are few studies on the use of topical antimicrobials, such as in dermatology and ophthalmology. Therefore, the purpose of this study was to investigate the use of topical AMU in Japan. Data on AMU in dermatology and ophthalmology were obtained from the 2017 National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. The number of dermatological products used was 58,396,530 in 2017. The proportions of betamethasone/gentamicin and gentamicin used were 50.5% and 16.7%, respectively, whereas that of the ingredient quantity in gentamicin was 7.8%. It has been suggested that topical AMU should be evaluated based on the number of products being used. The number of ophthalmological products used was 24,655,653 in 2017, and the proportion of quinolones used was 95.9%. The high prescription rate of quinolones may cause an increase in quinolone resistance in the ophthalmologic field. Topical AMU, which is a potential "blind spot" in the measures against AMR, needs to be continuously monitored, together with systemic AMU.

Current updates on herbal oil vs synthetic antibiotics use for topical application

Topical skin infections represent some of the most common infectious sicknesses globally. Prevention and treatment of skin infections can involve utility of a topical antimicrobial, which may be an herbal oil and synthetic antibiotic drug. However, there's restricted evidence to aid the widespread rophylactic or healing use of topical agents. Challenges concerned inside the use of topical antimicrobials encompass growing costs of bacterial resistance, local allergy reactions. We evaluate the proof for the foremost scientific makes use of herbal oil and topical synthetic antibiotics. Herbal oils are traditional herbal treatments used to deal with several situations. 5% of plant oils used for dermatological usages, pores and skin moisturizing and skin care. The benefits of this sort of therapeutics encompass properly availability, local cultural elements and individual choices. the growing demand for herbal and organic merchandise, and the already established synergistic consequences of natural oil. Synthetic antibiotics are beneficial for topical administration to treating topical skin condition rather than the oral administration because of minimising the side effect of oral administration. Nowadays topical antibiotics is widely accepted effective and safe treatment for bacterial infection. In this review article comparison of the herbal oil Vs synthetic antibiotic drug for topical use.

PENGARUH JUMLAH TOPIKAL AIR SUSU IBU TERHADAP LAMA PELEPASAN TALI PUSAT

The length of time that the cord is removed will allow infection which is the cause of death. WHO recommends treatment based on aseptic principles, but there is insufficient evidence to recommend routine use of topical antimicrobials for treatment. The incidence of tetanus neonatorum due to umbilical cord infection continues to increase and is at risk of causing death. Several studies have shown that breast milk is an alternative material for cord care because it is sterile, contains antiinflammatory and anti-infective properties. This study aims to determine the effect of the topical amount of breast milk on the duration of release. The research design used a quasi-experiment with a cohort approach. The sample in this study was 43 babies who were selected using consecutivesampling. Samples were divided into 3 treatment groups, namely newborns who met the inclusion criteria were given 5 drops, 7 drops, and 10 drops of breast milk to observe the duration of wound healing. Data collection using the observation sheet. The results showed the fastest wound healing time was given 5 drops of breast milk for 164,931 hours (164 hours 56 minutes), 10 drops for 170,173hours (170 hours 10 minutes), and 7 drops for 171,807 hours (171 hours 48 minutes). The results of the analysis using one-way ANOVA showed that the treatment of topical breastfeeding had no significant effect on the length of healing of cord wounds (F-count 0.393 with p-value 0.678). Topical breastfeeding responds differently to the healing of the baby's cord wound. Keywords: breast milk, length of umbilical cord release

Identifying critical immune effectors of the dermal wound healing response by innate cells using microporous-annealed-particle (MAP) hydrogel

Abstract The wound healing response is critical to maintain tissue function after injury. Inflammation is needed to sterilize the wound site, but this results in scar formation and impaired tissue function. Topical anti-microbial use, fetal wound healing, and limited studies in germ-free animals suggest that the degree of microbial contamination at a wound site positively correlates with scar formation and recovery time. However, tools to identify the molecular signals and cell types that alter tissue repair verses have been limited. Here we test the hypothesis that Danger-Associated-Molecular Patterns (DAMPs) released during sterile injury guide a fundamentally distinct wound healing response than Pathogen-Associated-Molecular-Patterns (PAMPs) using a novel microporous annealed particle hydrogel (MAP-gel). MAP-gel is an immunologically inert, injectable tissue matrix that is easily linked to a broad range of small signaling molecules. We show that subcutaneous injection of MAP-gel is a robust platform to identify innate immune signaling molecules and infiltrating cell types that control wound healing. Conjugating the model PAMP, LPS, to MAP-gel is sufficient to induce a fibrotic encapsulation response and alter infiltrating immune cell populations. To identify the candidate modulators, proteins enriched in MAP-gels isolated from non-inflammatory or LPS-driven inflammatory responses were identified by LC-MS. These candidates are being conjugated directly to MAP-gel to identify immune effectors that promote wound healing with the absence of fibrotic encapsulation. The modified MAP-hydrogel will be used to gain insight into the molecular mechanisms behind scaring and the unique role DAMPs play in tissue resolution.

Skin cleansing and topical product use in patients with epidermolysis bullosa: Results from a multicenter database.

Epidermolysis bullosa (EB) comprises a group of inherited skin blistering diseases. There is currently no cure, and management includes skin protection and prevention of infection. To date, there has been no systematic investigation of home skin care practices among EB patients on a multicenter scale. This cross-sectional, observational study included data collected from patients with EB enrolled in the Epidermolysis Bullosa Characterization and Clinical Outcomes Database (EBCCOD) who provided answers to a patient-directed questionnaire between January 1, 2017, and December 31, 2017. Of 202 respondents, 130 (64.4%) had dystrophic EB, 51 (25.2%) had EB simplex, 21 (7.4%) had junctional EB, 3 (1.5%) had Kindler syndrome, and 3 (1.5%) had an unspecified subtype. Seventy-eight patients reported cleansing in plain water only (39%). Of those who used an additive in their cleansing water, 75 (57%) added salt, 71 (54%) added bleach, 36 (27%) added vinegar, and 34 (26%) endorsed the use of an "other" additive (multiple additives possible). Reported concentrations of additives ranged widely from 0.002% sodium hypochlorite and 0.002% acetic acid solutions, which are thought to have negligible effects on microbes, to 0.09% sodium hypochlorite and 0.156% acetic acid, concentrations shown to be cytotoxic. One hundred eighty-eight patients answered questions regarding topical product use (93%). Of those, 131 reported topical antimicrobial use (70%). Mupirocin and bacitracin were the most commonly reported topical antibiotics (59, 58 [31.4%, 30.9%], respectively). These findings highlight the variety of skin care routines and frequent use of topical antimicrobials among EB patients and have potential implications for antibiotic resistance. The reported range of bleach and vinegar additives to cleansing water, including cytotoxic concentrations, emphasizes the need for clear and optimized skin cleansing recommendations.

A Point Prevalence Study of Antimicrobial Use and Practice Among Nursing Homes in Singapore.

Inappropriate antimicrobial use is a major cause for the development of antimicrobial resistance in nursing homes (NHs); however, little is known about antimicrobial use at NHs in Singapore compared with NHs in other countries. The aim of this study was to determine the prevalence, practice and challenges of antimicrobial prescribing in Singapore NHs compared with those in other countries. A point prevalence survey (PPS) was conducted from August to October 2017. Data on antimicrobial use and the quality of documentation were retrieved from medical and/or medication records of NH residents. Informed consent was obtained from the NH management. Nine of 73 NHs in Singapore, with a total of 1760 residents, participated in the PPS. The prevalence of oral antibiotic and topical antimicrobial use was 2% and 11%, respectively, and the worldwide point prevalence of antimicrobial prescribing in NHs ranged from 1-17% (median 8%). The key challenges identified locally were different from thoseof overseas NHs, including incomplete documentation of antimicrobial duration and indication of use, as well as the high prevalence of topical antimicrobial use. The prevalence of oral antibiotic use in NHs in Singapore was lower, while topical antimicrobial use was higher, compared with NHs in other countries. Variability in antimicrobial prescribing and challenges in practice among local and overseas NHs implied that a comprehensive PPS could be beneficial to aid in the design of effective and practicable antimicrobial stewardship strategies appropriate for the NH.

The downside of antimicrobial agents for wound healing.

The use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause of delayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewer systemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided into three groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore, this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, their disadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activity than antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still many adverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects of commonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin, mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, the antimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awareness for antimicrobial selection in those populations.

The widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from patients with atopic dermatitis.

SummaryBackgroundCarriage rates of Staphylococcus aureus on affected skin in atopic dermatitis (AD) are approximately 70%. Increasing disease severity during flares and overall disease severity correlate with increased burden of S. aureus. Treatment in AD therefore often targets S. aureus with topical and systemic antimicrobials.ObjectivesTo determine whether antimicrobial sensitivities and genetic determinants of resistance differed in S. aureus isolates from the skin of children with AD and healthy child nasal carriers.MethodsIn this case–control study, we compared S. aureus isolates from children with AD (n = 50) attending a hospital dermatology department against nasal carriage isolates from children without skin disease (n = 49) attending a hospital emergency department for noninfective conditions. Using whole genome sequencing we generated a phylogenetic framework for the isolates based on variation in the core genome, then compared antimicrobial resistance phenotypes and genotypes between disease groups.Results Staphylococcus aureus from cases and controls had on average similar numbers of phenotypic resistances per isolate. Case isolates differed in their resistance patterns, with fusidic acid resistance (FusR) being significantly more frequent in AD (P = 0·009). The genetic basis of FusR also differentiated the populations, with chromosomal mutations in fusA predominating in AD (P = 0·049). Analysis revealed that FusR evolved multiple times and via multiple mechanism in the population. Carriage of plasmid‐derived qac genes, which have been associated with reduced susceptibility to antiseptics, was eight times more frequent in AD (P = 0·016).ConclusionsThe results suggest that strong selective pressure drives the emergence and maintenance of specific resistances in AD.

A prospective study of drug utilization in patients attending ophthalmology outpatient department at KBN teaching and general hospital of Gulbarga, India

Background: Drug utilization studies are an important part of rational use of drugs. Assessment of drug use pattern especially in developing countries is becoming increasingly necessary to promote the rational use of drugs. This study was planned to prospectively assess the drug utilization pattern in Ophthalmology outpatient department at KBN teaching and General hospital.Methods: After approval from Ethics Committee, the prescriptions of 1000 outpatients were analyzed using a predesigned form to record information from the OPD prescriptions. Mentioned WHO drug use indicators and additional indices were analyzed: Average number of drugs per prescription, number of encounters with antibiotics, percentage of encounters with injections, percentage of drugs prescribed by their generic names, percentage of drugs prescribed from the National Essential Drug List (NEDL), etc.Results: Prescription analysis showed that the average number of drugs per prescription was 2.6. The drugs were prescribed in the several forms, predominant dosage form been topical eye drops (69.58%) followed by tablets (11.98%), ointments (10.17%) and capsules (6.6%). The ‘dosage form’ was indicated for all of the drugs prescribed, the ‘frequency’ of drug administration was present in 96.5% of the drugs, and the duration of treatment for 82% of the drugs prescribed. Topical Antimicrobial agents were the most commonly prescribed drugs. followed by anti-inflammatory and anti-allergic, lubricants, anti-glaucoma drugs, etc. Percentage of drugs prescribed by generic name and from NEDL was 7.98% and 55 % respectively.Conclusions: The prescription writing errors were less, however, there was very low generic prescribing and inadequate information about the duration of therapy in many prescriptions. Generic prescribing can be improved. Duration of therapy should be mentioned in all prescriptions. It is essential that appropriate guidelines on the use of topical antimicrobials are required to ensure rational prescribing.

Surgical antimicrobial prophylaxis.

Surgical antimicrobial prophylaxis is the most common indication for antimicrobial use in Australian hospitals. However, it is associated with high rates of inappropriate use. Effective use of antimicrobials to prevent infection is essential to reduce risks associated with surgical procedures. Efforts need to be made to maximise the quality of surgical antimicrobial prophylaxis prescribing. Procedural prophylaxis (before or during surgery) is not indicated for all surgeries, especially minor procedures. Post-procedural prophylaxis, including the use of topical antimicrobials, is rarely indicated yet frequently prescribed. The Therapeutic Guidelines: Antibiotic is a key reference for all Australian prescribers. GPs can have a significant role in optimising surgical antimicrobial prophylaxis and reducing the burden of inappropriate antimicrobial use.

Ivy Loop Wiring: A Useful Form of Endotracheal Tube Stabilization in Burn Patients.

The stabilization of endotracheal tubes in the burn population presents many problems. Access to the face for dressings, debridements, and the use of topical antimicrobials prevent adequate stabilization of the endotracheal tube with commonly used methods. Conventional methods have an increased risk of shifting, which can lead to injury to the friable burned tissue or unplanned extubation. To prevent these complications, alternative methods using the dentition to stabilize the endotracheal tube have been described. Here, we present our technique of using Ivy loops to secure the endotracheal tube. It is a simple method with low complications that provides a strong stabilization of the tube while giving access to the face.

Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns.

Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.

An in vitro investigation into the efficacies of chlorhexidine gluconate, povidone iodine and green tea (Camellia sinensis) to prevent surgical site infection in animals

Background: Surgical site infections are common in veterinary practice; their prevention is based on the preoperative use of topical antimicrobials at the surgical site to reduce resident bacteria to sub-pathogenic levels. Aim Chlorhexidine gluconate (CHG) and povidone iodine (PI) are the most popular options for preoperative skin preparation in veterinary practice, however increasing bacterial resistance to CHG and PI have been reported; therefore investigation into alternative antimicrobials such as Camellia sinensis (green tea: GT) is required. Method The Kirby-Bauer disk diffusion method was used to test the antibacterial activity of four dilutions of CHG, PI and GT on the normal flora of animal skin, represented by S. aureus, S. intermedius, S. uberis and S. pyogenes. Zones of inhibition (ZOI) were measured to assess antimicrobial action. Kruskal-Wallis analyses with Mann-Whitney post-hoc tests determined differences in efficacy between the dilutions of antimicrobials for each bacterium tested. Results All antimicrobials inhibited bacterial growth, CHG was more efficacious than PI and GT (p&lt;0.0001; mean CHG: 24.02± 2.05 mm; mean PI: 4.46±1.35 mm; mean GT: 2.90mm±2.60mm). Although GT produced smaller ZOIs than PI, no significant differences in efficacy existed (p&gt;0.05). Conclusion The results suggest that CHG is the best antimicrobial for preoperative skin preparation. GT did produce an antibacterial effect on three of the four bacteria, although this was inferior to the existing veterinary products used. Therefore GT in the formulation tested is not recommended for use as a veterinary antimicrobial.

Infections in critically ill burn patients

Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns.Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated.Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.