mafenide [Topical]

Adult Dosing

Infections; burn wounds

Cream:

Apply cream qd-bid in a thickness of 1/16 inch to cleansed debrided areas
Apply with a sterile gloved hand
May/may not use dressings. However, if a dressing is necessary, apply only a thin layer
Continue treatment until healing is progressing well or until the burn site is ready for grafting

Solution:

Apply 5% sol q6-8 hrs or PRN to keep dressing wet
Cover grafted area with 1 layer of fine mesh. Cut an 8-ply dressing to the size of the graft and wet with 5% solution using an irrigation syringe and/or irrigation tubing. If irrigation tubing not used, moisten the gauze dressing q6-8 hrs or as needed
Continue until autograft vascularization occurs and healing progresses (typically occurring in about 5 days)

Pediatric Dosing

Note: Safety and effectiveness in pediatric patients <3 months have not been established [CRE]

Infections; burn wounds

Children >3 mo

Cream:

Apply cream qd-bid in a thickness of 1/16 inch to cleansed debrided areas
Apply with a sterile gloved hand
May/may not use dressings. However, if a dressing is necessary, apply only a thin layer
Continue treatment until healing is progressing well or until the burn site is ready for grafting

Solution:

Apply 5% sol q6-8 hrs or PRN to keep dressing wet
Cover grafted area with 1 layer of fine mesh. Cut an 8-ply dressing to the size of the graft and wet with 5% solution using an irrigation syringe and/or irrigation tubing. If irrigation tubing not used, moisten the gauze dressing q6-8 hrs or as needed
Continue until autograft vascularization occurs and healing progresses (typically occurring in about 5 days)

[Outline]

Adult Dosing
Pediatric Dosing

Indications ⬆ ⬇

Adjunct in 2nd and 3rd degree burns [Cream]
Adjunct to control bacterial infection when used under moist dressings over meshed autografts on excised burn wounds [Solution]

Contraindications ⬆ ⬇

Known hypersensitivity to mafenide

Black Box Warnings ⬆ ⬇

Dosing Adjustment ⬆ ⬇

Renal Dose Adjustment

Renal impairment: Use with caution; monitor acid base balance closely. Dose adjustments not defined

Hepatic Dose Adjustment

Hepatic impairment: Dose adjustments not defined

Warnings/Precautions ⬆ ⬇

See Supplemental Patient Information

May cause metabolic acidosis; close monitoring of acid base balance is necessary (esp. with extensive 2nd degree or partial thickness burns, pulmonary or renal impairment)
Masked hyperventilation with resulting respiratory alkalosis has occurred
May cause pain/burning sensation, rash, pruritis, erythema, skin maceration (from prolonged wet dressings)

Cautions: Use cautiously in

Acute renal impirment
Pulmonary dysfunction
G-6PD deficiency
Sulfite sensitivity
Asthma

Supplemental Patient Information

Advise patients to contact physican if condition worsens, if irritation occurs, or if hyperventilation occurs

Pregnancy/Breast Feeding ⬆ ⬇

Pregnancy Category:C

Breastfeeding: It is not known whether mafenide is excreted in breastmilk. Manufacturer recommends discontinuation of breastfeeding, or discontinuation of treatment (taking into account the importance of the drug to the mother).

Adverse Reactions ⬆ ⬇

DERM: Pain on application/burning sensation, excoriation of new skin, bleeding of skin
HYPERSENSITIVITY: Rash itching, facial edema, swelling, hive, blisters, erythema, eosinophilia
RESP: Tachypnea/hyperventilation, decrease in arterial pCO₂
METABOLIC: Acidosis, increase in serum chloride
GI: Diarrhea
HEMA: Coagulation disorder, hemolytic anemia, bone marrow depression

Clinical Pharmacology ⬆ ⬇

Topical anti-infective; mechanism of action is unknown; works by reducing the bacterial population present in the avascular tissues of burns and permits spontaneous healing of deep partial-thickness burns
Topical mafenide is delivered to burned tissue over a 4 hr period following application
Metabolized by liver
Renally excreted
Half-Life: Unknown

Brands and Availability ⬆ ⬇