Burns - Initial Management Drug Summary

Last updated: 12 August 2026
Reviewed by

Anaesthetics - Local & General

Drug Dosage Remarks
Lidocaine Apply to affected area 6-8 hourly Adverse Reactions
  • Allergic reaction
Special Instructions
  • Do not use in or near the eyes
  • Discontinue if allergic reaction occurs or condition worsens or does not improve within 7 days

Analgesics (Non-Opioid)*

Drug Dosage Remarks
Ibuprofen 5-10 mg/kg PO 6-8 hourly
Max dose: 40 mg/kg/day 		Adverse Reactions
  • Generally well-tolerated
  • GI effects (peptic ulceration, GI bleeding, dyspepsia, heartburn, nausea/vomiting, anorexia, diarrhea, constipation, stomatitis, flatulence, bloating, epigastric and abdominal pain, jaundice, transient increase in hepatic enzymes); CNS effects (headache, dizziness, nervousness, depression, drowsiness, insomnia, blurred vision, emotional lability, hallucinations and pseudotumor cerebri, paresthesia); Dermatologic effects (skin rash, pruritus, tinnitus, edema, hypersensitivity); Renal effects (acute renal failure with acute tubular necrosis, polyuria, azotemia, cystitis, hematuria, decreased CrCl); Hematologic effects (neutropenia, aplastic anemia, agranulocytosis, hemolytic anemia, thrombocytopenia)
Special Instructions
  • Contraindicated in patients with hypersensitivity to Ibuprofen, advanced kidney and liver diseases, dengue fever, asthma and active GI bleeding
Paracetamol
(Acetaminophen)		 10-15 mg/kg/dose PO/rectum 6-8 hourly
or
2-12 years old (<33 kg):
75-300 mg IM 4-6 hourly
>12 years old (>33 kg):
300-450 mg IM 4-6 hourly
or
>10 kg-<33 kg: 15 mg/kg slow IV 6 hourly
Max dose: 2 g/day
>33 kg-<50 kg: 15 mg/kg slow IV 6 hourly
Max dose: 3 g/day
>50 kg: 1 g slow IV 6 hourly
Max dose: 4 g/day 		Adverse Reactions
  • Generally well-tolerated
  • Skin rashes and other hypersensitivity reactions occur occasionally
  • Overdose may result in severe liver damage and acute tubular necrosis
Special Instructions
  • Use with caution in patients with impaired kidney or liver function
  • Use with caution in patients with hematologic disorders
*Combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Analgesics (Opioid)

Drug Dosage Remarks
Methadone 2.5 mg PO 8-12 hourly Adverse Reactions
  • Respiratory depression, cardiac arrhythmias
Special Instructions
  • Avoid in patients with shock, copious bleeding
  • Use with caution in patients taking benzodiazepines
Morphine Acute pain:
0.1-0.2 mg/kg SC/IM 4-6 hourly
or
0.05-0.1 mg/kg very slow IV
Max dose: 15 mg/dose 		Adverse Reactions
  • CNS effects (lightheadedness, confusion, headache, asthenia, dizziness, sedation, insomnia, involuntary muscle contractions, somnolence, thought abnormality); GI effects (abdominal pain, anorexia, dry mouth, dyspepsia, nausea/vomiting, constipation); Respiratory effects (bronchospasm, decreased cough); Other effects (rash, pruritus, chills, sweating)
Special Instructions
  • May lead to tolerance and dependence
  • Avoid abrupt discontinuation of therapy
  • Use with caution in patients with hepatic and renal impairment
  • Contraindicated in patients with pheochromocytoma
Nalbuphine 0.1-0.2 mg/kg IM/IV/SC 3-6 hourly, as needed
Max dose: 20 mg/dose or 160 mg/day 		Adverse Reactions
  • Headaches and respiratory depression may occur
  • May precipitate withdrawal symptoms
  • Less common: Nausea/vomiting
  • Rare: Hallucinations
Special Instructions
  • Use with caution in patients with hepatic or renal impairment

Emollients, Cleansers & Skin Protectives

Drug Available Strength and/or Preparations Dosage Remarks
Dexpanthenol 2-5% cream, ointment, solution Apply on affected area as needed Special Instructions
  • Hypersensitivity has been reported
Petroleum jelly 100% jelly Apply thinly on affected area as needed Special Instructions
  • Hypersensitivity reactions and acne reported
Zinc oxide 7.5%, 10%, 15%, 18.5%, 32%, 310 mg/g cream;
3.8%, 7.5%, 10%, 20%, 40%, 200 mg/g ointment;
paste; topical powder		 Apply on affected area 12-24 hourly Special Instructions
  • Avoid application on open wounds with bacterial/fungal infection

Intravenous & Other Sterile Solutions

Drug Dosage Remarks
Human albumin 20-80 g/day (100-400 mL) IV infusion at 1 mL/min Adverse Reactions
  • Local effect (allergic reaction); Other effects (hypotension, chills, fever)
Special Instructions
  • Avoid in patients with heart failure (HF), pulmonary edema, severe anemia
Hydroxyethyl starch/NaCl 10-20 mL slow IV infusion
Dose and rate of maintenance/continuous infusion depends on the patient’s needs, hemodynamics and hydration status 		Adverse Reactions
  • Pruritus and anaphylactoid reactions (bradycardia, bronchospasm)
Special Instructions
  • Avoid in patients with severe liver disease, renal failure, preexisting coagulation or bleeding disorders
  • Regularly assess fluid status and rate of infusion
Plasma protein fraction (human) 250-500 mL IV
Adjust dose based on clinical response 		Adverse Reactions
  • Local effects (flushing, urticaria); Other effects (hypotension, back pain, nausea, headache)
Special Instructions
  • Avoid in patients with severe hypotension, severe anemia, HF
Polygeline 20 mL/kg/day (500-1,500 mL) IV infusion
Max dose: 2,000 mL 		Adverse Reactions
  • Local effect (urticaria); Other effects (hypotension, chills)
Special Instructions
  • Use with caution in patients with cardiac insufficiency, cardiogenic shock

Other Dermatologicals*

Drug Dosage Remarks
Boric acid Apply to affected area 8-12 hourly Special Instructions
  • Avoid repeated and prolonged application to large and/or denuded affected areas
Hyaluronic acid Apply to affected area 12 hourly or as needed Special Instructions
  • Avoid in patients with hypersensitivity
Polysiloxane Apply to affected area 12-24 hourly Special Instructions
  • Avoid contact with eyes
Silicone Apply to affected area 12 hourly Special Instructions
  • Do not apply to open or wet wounds and any wound near the eyes
  • Avoid exposure of lesions to extreme temperatures and intense sunlight
Titrated extract of Centella asiatica
(Centella asiatica extract)		 Apply to affected area 12-24 hourly Adverse Reactions
  • Pruritus, burning sensation, eczema
Special Instructions
  • Avoid in deep wounds
*Combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Skin Antiseptics & Disinfectants

Drug Available Strength Dosage Remarks
Aloe vera 87.4% gel Apply to affected area every 30 minutes until burn pain disappears, then apply 8-12 hourly Adverse Reactions
  • Mild skin irritation
Cetrimide 0.1%, 0.5% cream Apply to affected area 8-12 hourly Adverse Reactions
  • Skin irritation, occasional sensitization
Special Instructions
  • Avoid contact with eyes
  • Avoid use in body cavities
Chlorhexidine 0.02%, 0.5%, 4%, 5% solution
1% cream		 Apply sufficient undiluted amount, rub until dry Special Instructions
  • Avoid contact with eyes and ears
Feracrylum 1% gel, solution Apply to affected area directly or with gauze for 1-3 minutes until bleeding stops Special Instructions
  • Not for IM/IV injection
  • Avoid concomitant use with aminocaproic acid
Povidone-iodine Cream, ointment, solution, spray Apply/spray to affected area 8 hourly
May cover with dressing or bandage		 Adverse Reactions
  • Local irritation
Special Instructions
  • Caution in patients with Iodine idiosyncrasy
Triclosan/Allium cepa extract 0.3% gel Apply to affected area 8-12 hourly Adverse Reactions
  • Contact dermatitis

Surgical Dressings & Wound Care

Drug Dosage Remarks
Calcium alginate Apply a single layer on the wound and cover with suitable dressing Adverse Reactions
  • Local irritation
Chlorhexidine acetate Apply directly on previously cleaned wound as dressing >1/day or 2x/week Special Instructions
  • Avoid contact with eyes and ears
Collagen Apply directly on sterilized wound
May secure with gauze and adhesive plaster		 Adverse Reactions
  • Rare: Hypersensitivity
Special Instructions
  • Avoid contact with eyes
  • Use with caution in patients with hepatic impairment and biliary obstruction, premature neonates
  • Framycetin: Cross-sensitization with Neomycin and Kanamycin; use with caution in patients with renal impairment
Framycetin Apply directly on previously cleaned wound as dressing 24 hourly
Fusidic acid
(Fusidate, Na fusidate)
Hydrocolloid Apply directly on previously cleaned wound as dressing Special Instructions
  • Avoid in patients with hypersensitivity
Ionic silver/Na carboxymethyl-cellulose Apply directly on sterilized wound
Dressing should overlap 5 cm
(2 inches) onto the skin surrounding the burn and should be covered with sterile gauze and secured in place		 Special Instructions
  • Avoid in patients with hypersensitivity
  • Seek consult if with signs of infection, bleeding, change in wound color and/or odor, maceration and no signs of healing
Lyo acellular fish skin Apply directly on previously cleaned wound
May apply second non-adherent dressing to maintain a moist wound environment		 Special Instructions
  • Avoid in patients with hypersensitivity to fish material
Melaleuca oil Apply to burn area
May bind lightly with bandage		 Special Instructions
  • Use for minor burns only after initial first aid treatment
Nanocrystalline Ag Moisten with sterile water then apply to affected area
May apply second dressing to secure in place		 Adverse Reactions
  • Temporary skin discoloration
Special Instructions
  • Avoid in patients with hypersensitivity or undergoing MRI scan
Octenidine diHCl Apply single or double layer of dressing to wound and cover with secondary dressing Adverse Reactions
  • Dermatitis, contact sensitivity or photosensitivity
Special Instructions
  • Should not be used on >10% of body area
  • Avoid contact with eyes, middle ear, meninges and brain
Polyurethane1 Apply on previously cleaned and dried wound Special Instructions
  • Replace after 2-3 days or when discharge flows out
  • Seek consult prior to use in patients with would-healing difficulty (eg DM), symptoms of infection and if wounds are not healed within 4 days
Protein-free hemodialysate Apply thinly 12-24 hourly and cover with dressing until wound has healed Adverse Reactions
  • Unpleasant stinging after application
Special Instructions
  • Avoid in patients with hypersensitivity to parahydroxybenzoates
Recombinant human epidermal growth factor Apply to wound 12 hourly Adverse Reactions
  • Itchiness, rash, pain, swelling
Special Instructions
  • Avoid in patients with hypersensitivity and avoid contact with eyes and ears
Sodium hyaluronate Gauze pad: Apply ≥1x/day
Cream: Apply on affected area 8-12 hourly		 Adverse Reactions
  • Skin rash, ecchymoses
Special Instructions
  • Avoid in patients with hypersensitivity
Zinc hyaluronate Apply thinly on affected area Adverse Reactions
  • Redness, mild transient stinging or burning sensation
1Combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Topical Antibiotics

Drug Dosage Remarks
Amikacin Apply on affected area 12-24 hourly Special Instructions
  • Ototoxicity, nephrotoxicity, neurotoxicity; assess audiogram test in patients with renal insufficiency and blood creatinine levels
Bacitracin Apply on affected area 8-24 hourly Adverse Reactions
  • Deafness, nephrotoxicity
  • Rare: Hypersensitivity
Special Instructions
  • Absorption is negligible with topical use
  • Excessive skin damage with prolonged use
Chloramphenicol Apply on affected area 6-8 hourly Adverse Reactions
  • Hypersensitivity reactions (burning, itching, redness)
Special Instructions
  • Avoid prolonged or extended use
Fusidic acid
(Fusidate, Na Fusidate)		 Apply on affected area 8-12 hourly Adverse Reactions
  • Rare: Hypersensitivity
Special Instructions
  • Avoid contact with eyes
  • Use with caution in patients with hepatic impairment and biliary obstruction
Gentamicin sulfate Apply on affected area 6-8 hourly Adverse Reactions
  • Local irritation
Special Instructions
  • Discontinue use if irritation occurs
Mafenide Apply a 16-mm layer on affected area 12-24 hourly Adverse Reactions
  • Local effects (pain or burning sensation, allergic reaction); Other effect (bleeding)
Special Instructions
  • Clean area before application
  • May apply under moist dressing
Mupirocin Apply on affected area 8 hourly Adverse Reactions
  • Usually well-tolerated
  • Local itching, burning or stinging, dryness may occur
Special Instructions
  • Contraindicated in patients with hypersensitivity to Mupirocin
  • Not to be used on mucous membranes
  • Use with caution in patients with renal impairment
Neomycin sulfate Apply on affected area 8-12 hourly Adverse Reactions
  • Usually well-tolerated
  • Local irritation may occur
Nitrofurazone
(Nitrofural)		 Apply on lesion or place first on gauze then apply on lesion Adverse Reactions
  • Contact dermatitis, superinfection
Special Instructions
  • Contraindicated in patients with known hypersensitivity
  • Use with caution in patients with renal impairment
Oxytetracycline Apply on affected area 8-12 hourly Adverse Reactions
  • Local irritation
Special Instructions
  • Contraindicated in patients with known hypersensitivity
Tetracycline Apply on affected area 12-24 hourly Special Instructions
  • Contraindicated in patients with known hypersensitivity
Silver sulfadiazine Apply 2-3 mm on affected area 24 hourly Adverse Reactions
  • Transient leukopenia, argyria
  • Less common: Local pain or irritation
Special Instructions
  • Contraindicated in those with liver and renal insufficiency, infants
  • Use with caution in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency
Sulfasomidine Apply thin layer over affected area Adverse Reactions
  • Allergic reactions
Special Instructions
  • Contraindicated in patients with known hypersensitivity to sulfonamides

Topical Antihistamines/Antipruritics

Drug Dosage Remarks
Pramoxine HCl Apply to affected area 6-8 hourly Adverse Reactions
  • Skin sensitization
Special Instructions
  • Do not apply to eyes or open skin lesions

Topical Corticosteroids

Drug Dosage Remarks
Desoximetasone Apply to affected area 8-24 hourly Adverse Reactions
  • Local effects (acne, skin pigmentation, skin atrophy)
Special Instructions
  • Avoid long-term treatments and applying to large areas or near eyes

Vaccines, Antisera & Immunologicals

Drug Dosage Remarks
Immunoglobulin
Human tetanus immunoglobulin 250 IU IM for 1 dose
May increase to 500 IU IM
Extensive burns: Administer second injection of 250 IU IM after exudative phase of burn (>36 hours after onset of burn) 		Adverse Reactions
  • Local effects (pain, redness, tenderness, injection site reactions); Other effects (chills, fever, malaise, headache, anaphylactic shock, angioneurotic edema, nephritic syndrome)
Special Instructions
  • Not to be given IV
  • Use with caution in patients with coagulation disorders and thrombocytopenia
  • Use different syringes and injection sites when given concurrently with tetanus vaccine
Vaccine
Tetanus toxoid
(Tetanus toxoid, adsorbed)		 Clean Minor Wound
Not/partially immunized:
0.5 mL/dose for 1 dose
>10 years since last booster dose with complete immunization:
0.5 mL/dose for 1 dose
Clean Major/Tetanus-Prone Wound
Not/partially immunized:
0.5 mL/dose for 1 dose*
5-10 years since last booster dose with complete immunization:
0.5 mL/dose for 1 dose
>10 years since last booster dose with complete immunization:
0.5 mL/dose for 1 dose*
Tetanus-Prone/Delayed/Incomplete Debridement
Not/partially immunized:
0.5 mL/dose for 1 dose**
5-10 years since last booster dose with complete immunization:
0.5 mL/dose for 1 dose
>10 years since last booster dose with complete immunization:
0.5 mL/dose for 1 dose** 		Adverse Reactions
  • Local effects (pain, redness, induration, injection site reactions); Other effects (fever, enlarged lymph nodes, allergic reactions, dizziness, hypotension, headaches, muscle pain, joint pains)
Special Instructions
  • Shake ampule gently before injection
  • Recommended site of injection: Arm via IM/deep cutaneous route
  • Not recommended for patients with history of neurological disorder or allergic reaction to vaccines
  • Caution when giving to patients with febrile illness, acute infection, chronic disease, immunodepression, or with history of abnormal reaction to vaccines
*Given with Human tetanus immunoglobulin 250 IU in the other arm.
**Given with Human tetanus immunoglobulin 500 IU in the other arm and antibiotics.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.