Anti-Infection Therapy for Systemic Treatment with BRT with MEBT/MEBO

There are two pathogenic types of postburn infections, one is a natural pathogenesis; the other is a subsequent infection postburn. 

The natural pathogenesis is similar, in some aspects but considerably different to the "primary infection" reported by typical surgical burn treatments. The former still consists of subclinical infections, which means that the possibility of postburn infection is a natural reaction of burns. 

The subsequent infection demonstrated the same syndrome as reported from surgical burn treatments, and consists of postburn infection caused by all exogenous sources and factors. The principles of anti-infection treatment are as follows:

1. The principle of routine treatment

Generally, all burn patients with TBSA > 30 % (TBSA > 10 % in children) must be treated with systemic anti-infection routinely whether infection occurs or not. 

The principle is: to apply one or more powerful broad-spectrum antibiotics as early as possible after injury until the 5th to 7th day for massive deep II degree burns and the 7th to 10th day for massive III degree burns via intramuscular injection or intravenous drips. 

The more extensive the TBSA and depth of wounds, the more powerful antibiotics and broader spectrum antimicrobials are required. 

After 7 days for deep II degree or 10 days for deep III degree burns, promptly discontinue applying all antibiotics regardless of what the patients' condition may be.

2. Heteropathy anti-infection treatment

(1) Principles : In order to prevent and treat subsequent infections including infections that occurred after routine treatments, the heteropathy "anti-infection treatment" should be applied. However, it is initially very important to eliminate any factors that may cause subsequent infections, which is a key point to diagnosing infections during the treatment of burns. 

The pathogenic course of burns is further complicated by inflammation and infection. Patients with fever and increased heart rates, etc., should be diagnosed with extreme caution and care in terms of handling infection and systemic treatments with antibiotics.

After postburn routine treatment, the burned body needs to regulate itself so that internal organs can recover and the would repair can be initiated. Thus, thoughtful and timely measured applications of antibiotics must be followed along with avoiding any interference with the body's normal functions.

(2) Indications : Infection happened when three clinical manifestations occur simultaneously, i.e.

A. body temperature >39.5℃or < 36.0℃;
B. heart rate >140/min;
C. appearance of toxic granules in neutrophils leukocytes.

Timely and careful monitoring is required.

(3) Strategy : One layer dose of one or more powerful broad-spectrum antibiotics without renal damage should be applied. 

It can be used once again, and then stopped if the toxic granules in neutrophils disappear. The patients should be re-examined to eliminate any factors of subsequent infections, and treated with other antibiotics if the indications of infection are not improved or even exacerbated. 

Inefficacy of using antibiotics is commonly due to the presence of systemic infection and the fact that the focus area, which is the primary center where the infection is localized just under the wound, may be located too far from the concentration of the administered antibiotics. 

So inefficacy or foci of infection may be noticed at the localized "focus" area where antibiotic concentrations are not so strong or effective. Patients suffering from general asthenia should take fresh blood infusions to regulate their internal balance. 

Abuse of antibiotics without indications of infection is strictly forbidden!

Bacterial infections interfere with the discharge of necrotic tissues and maintenance of a moist physiological environment.

In "Burn Regenerative Therapy", an unsuitable environment for bacterial growth is provided by several components in MEBO together with the moist physiological environment of the wound. 

In this environment, pathogenic bacterial aggregation is promoted, invasion is prevented, and toxin production is inhibited.

This controls bacterial infection without blocking skin regeneration.