Previous studies indicated that combining cerium nitrate with silver sulfadiazine (Silvadene, Marion Labs) yields a superior topical agent for the treatment of burns. Cerium nitrate in silver sulfadiazine was tested in a controlled study with silver sulfadiazine alone. The study population consisted of 2 groups of children suffering burns greater than 30% of the body surface. The patients ranged in age from 1-21 yr. The study period was for the first 10 wk of hospitalization. Quantitative surface cultures were used to monitor burn wound flora. No superiority for the silver sulfadiazine-cerium nitrate combination was demonstrated. Cultures indicate a significantly greater percentage of Gram-negative pathogens in patients treated with the cerium mixture. Cerium nitrate could possibly prove of greatest benefit if used as a reserve therapy for colonizing organisms which do not routinely respond to silver sulfadiazine.