What is the prescription cream for burns? An overview of Silver Sulfadiazine and other topical treatments

October 11, 2025 •

4 min read

According to the World Health Organization, millions of burn injuries occur annually, many of which require advanced medical treatment to prevent infection. For managing moderate to severe burns, knowing what is the prescription cream for burns is crucial, as topical antimicrobial medications are a cornerstone of preventing serious wound infections.

Quick Summary

Silver Sulfadiazine (Silvadene) is the most common prescription cream used for second- and third-degree burn infections. It is a topical antibiotic that prevents bacterial growth in wounds. Other specialized prescription and over-the-counter options are also available, depending on the severity and type of burn injury.

Key Points

Silver Sulfadiazine is the main prescription cream used to prevent and treat infections in second- and third-degree burns.
Proper application is critical and involves cleaning the wound, wearing sterile gloves, and maintaining consistent coverage of the cream on the burn area.
Contraindications and side effects exist, including sulfa allergies, use in pregnant women near term, and infants under 2 months.
Other prescription creams, like Mafenide, may be used for specific burn characteristics, such as when deep eschar penetration is needed.
Over-the-counter (OTC) options are for minor burns only, and any serious burn requires immediate medical attention.
Professional medical evaluation is necessary for all significant burn injuries to determine the best course of treatment and prevent complications.

The Role of Prescription Burn Creams

Severe burns create an ideal environment for bacterial infections, which can worsen the injury and delay healing. To combat this risk, doctors often prescribe topical antimicrobial creams. These medications help protect the damaged skin barrier and prevent complications like wound sepsis. A medical professional must always assess and diagnose burns to determine the appropriate course of action, as self-treating anything beyond a minor, first-degree burn is not recommended.

The Primary Prescription: Silver Sulfadiazine (Silvadene)

Silver Sulfadiazine is a topical sulfonamide antibiotic that is widely recognized as the standard prescription treatment for burn wounds. It is specifically indicated for preventing and treating wound infections in patients with second- and third-degree burns.

How Silver Sulfadiazine Works

This powerful cream works by releasing silver ions, which have broad-spectrum antimicrobial activity against a wide range of bacteria and even yeast. The silver ions disrupt the cellular membranes and walls of bacteria, effectively killing them or inhibiting their growth. This action makes the medication highly effective in controlling the bacterial colonization that often occurs on burn wounds.

Proper Application and Precautions

Proper application of Silver Sulfadiazine is critical to its effectiveness and patient safety. Your doctor will provide specific instructions, but general guidelines include:

Wound Preparation: Before each application, the wound should be thoroughly cleaned and any loose, dead skin (debrided) removed.
Sterile Technique: Always wear sterile gloves when applying the cream to prevent introducing new bacteria to the wound.
Thin Layer: Apply a thin layer (about 1/16 inch or 0.2 cm) of the cream to cover the affected area completely.
Consistent Coverage: The cream should cover the burn at all times. Reapply it if it is rubbed off by clothing or washed away during bathing.
Duration of Treatment: Continue use as long as your doctor prescribes, typically until the wound has healed or is ready for skin grafting.

Important Side Effects and Contraindications

While generally safe, Silver Sulfadiazine has specific contraindications and potential side effects. It should not be used in:

Infants under 2 months old: Due to the risk of kernicterus.
Pregnant women approaching term: For the same reason.
Individuals with sulfa allergies: A history of hypersensitivity to sulfa drugs is a clear contraindication.

Common side effects can include a temporary burning sensation, itching, rash, or skin discoloration. In rare cases, more serious reactions like skin necrosis, erythema multiforme, or a temporary decrease in white blood cell count (leukopenia) can occur. Regular monitoring by a healthcare provider is essential, especially for extensive burns.

Other Prescription and Over-the-Counter Options

While Silver Sulfadiazine is the most common, other topical treatments may be used depending on the specific burn type and patient needs.

Mafenide (Sulfamylon)

Mafenide is another prescription-only sulfonamide antibacterial agent used for second- and third-degree burns. Unlike Silver Sulfadiazine, it is known to penetrate the eschar (the dry, black scab formed over the burned area) more effectively, which can be advantageous in some cases. However, a notable side effect is that it can inhibit carbonic anhydrase, which may disrupt the body's acid-base balance.

Mupirocin (Bactroban)

Mupirocin is a prescription antibiotic cream sometimes used for burn wounds, particularly when there is a known or suspected infection from methicillin-resistant Staphylococcus aureus (MRSA). It is not a primary prophylactic burn cream but a targeted antibiotic for specific infections. Its use should be guided by a healthcare provider and limited in duration to avoid promoting antibiotic resistance.

Over-the-Counter Antibiotics

For minor, first-degree burns, over-the-counter (OTC) antibiotic ointments like Bacitracin or Neosporin (which contains Bacitracin, Polymyxin B, and Neomycin) are often used to prevent infection. These are generally not suitable for deep or extensive burns and should only be used for minor injuries.

Comparing Common Burn Treatment Creams

To help differentiate between common burn treatment options, the following table provides a quick comparison. Always consult a healthcare provider for any significant burn injury.


Feature	Silver Sulfadiazine (Rx)	Mafenide (Rx)	OTC Antibiotic (e.g., Bacitracin)	Medihoney (OTC)
Indication	Second- & third-degree burns	Second- & third-degree burns	Minor, first-degree burns	Minor burns, wounds
Mechanism	Broad-spectrum antibiotic via silver ions	Broad-spectrum antibiotic via sulfa compound	Antibacterial action	Antibacterial, moist wound environment
Eschar Penetration	Limited	High	N/A	Variable
Potential Systemic Effects	Risk of leukopenia, sulfa absorption	Acid-base balance disruption	Minimal; local reaction risk	Minimal
Contraindications	Sulfa allergy, pregnancy (near term), infants under 2 months	Known contraindications for sulfa drugs	Allergic reactions to ingredients	Allergic reactions

Conclusion

Understanding what is the prescription cream for burns is essential for those dealing with serious thermal injuries. Silver Sulfadiazine is the most frequently prescribed topical antibiotic for second- and third-degree burns, helping to prevent and treat infections. Other options like Mafenide and Mupirocin may be used in specific clinical situations. For minor burns, over-the-counter antibiotic ointments are typically sufficient. However, the most critical takeaway is that any burn beyond a minor, superficial injury requires immediate medical evaluation and professional treatment to ensure proper care, minimize the risk of infection, and promote optimal healing.

Frequently Asked Questions

A prescription cream like Silver Sulfadiazine is necessary for second- and third-degree burns, which are more severe and have a high risk of developing infections. These creams provide powerful antimicrobial protection that over-the-counter products cannot offer.

No, Silver Sulfadiazine is not intended for mild sunburns. Sunburns are typically first-degree burns and can be treated with soothing remedies like aloe vera. Silver Sulfadiazine is reserved for more serious second- and third-degree burns as prescribed by a healthcare provider.

Inform your doctor and pharmacist of any known allergies, especially to sulfonamide medications, before using Silver Sulfadiazine. Symptoms of an allergic reaction can include rash, hives, or swelling. If you have a known sulfa allergy, a doctor will likely prescribe an alternative.

The typical application for Silver Sulfadiazine cream is once or twice a day. However, always follow your doctor's specific instructions for dosing and duration of treatment.

Yes, some alternatives exist. For example, Medihoney is a medical-grade honey cream with natural antibacterial properties used for minor burns and wounds. For severe burns, a doctor might use special dressings containing silver (silver-impregnated dressings).

Prescription burn creams are typically stronger topical antimicrobial agents used for severe second- and third-degree burns, where infection risk is high. OTC creams are less potent and are intended only for minor, first-degree burns to prevent mild infection.

If you notice signs of worsening infection, such as increased pain, redness, swelling, warmth, or pus, contact your healthcare provider immediately. They will evaluate the wound and determine if a change in treatment is necessary.