Compare topical antimicrobials used in burns, focusing on spectrum, tissue penetration, and cautions between silver sulfadiazine and mafenide acetate.

• A. Silver sulfadiazine provides broad-spectrum coverage with limited eschar penetration and may be avoided in sulfa allergy; mafenide acetate penetrates eschar well, but can cause metabolic acidosis and pain; choice depends on burn depth and infection risk.
• B. Silver sulfadiazine penetrates deep eschar well and causes no side effects.
• C. Mafenide acetate has no risk of metabolic acidosis.
• D. Both have identical spectrum and penetration.

Answer: (A)

Topical antimicrobials for burns are chosen by weighing spectrum of activity, how well the drug penetrates through eschar to reach the wound bed, and patient cautions. Silver sulfadiazine provides broad coverage against many organisms but its penetration into necrotic eschar is limited, so deeper tissue infection may be less controlled; it also carries the risk of sulfa allergies. Mafenide acetate penetrates eschar and underlying tissues more effectively, which is advantageous for thick or deep burns, but it can cause metabolic acidosis due to systemic absorption and can be painful on application. Therefore, the best choice depends on burn depth and infection risk, balancing the need for deeper penetration against potential adverse effects. Statements claiming deep eschar penetration with no side effects, or no risk of metabolic acidosis, or identical spectrum and penetration, are not accurate.