mafenide
Regulatory sources consulted
Approved indications
- Adjunctive antibacterial treatment of second- and third-degree burns.
Contraindications
Absolute
- Hypersensitivity to mafenide or any component.
Clinical warnings
- Major warning · Carbonic anhydrase inhibition may cause metabolic acidosis. Monitor acid–base status, especially with extensive burns, pulmonary dysfunction, or acute renal failure. — DailyMed/openFDA, SPL set ID 008eaa23-8f19-4e39-85ff-540c1c834a9e
- Major warning · Fatal hemolytic anemia and disseminated intravascular coagulation have been reported, particularly with G6PD deficiency. The product’s sulfite may cause anaphylactoid reactions, especially in people with asthma. — DailyMed/openFDA, SPL set ID 008eaa23-8f19-4e39-85ff-540c1c834a9e
Adverse events
Common (≥1%)
Application-site pain or burning
Rare but serious
Hemolytic anemia with disseminated intravascular coagulation · Metabolic acidosis
Pregnancy and lactation
Not recommended in women of childbearing potential unless burns exceed 20% of body surface area or expected benefit justifies the risk. During breastfeeding, decide whether to stop breastfeeding or stop the medicine.
Recent literature (PubMed)
As a key mediator of pyroptosis, Gasdermin D (GSDMD) drives pro-inflammatory cell death through caspase-mediated cleavage to form membrane pores, which is closely linked to the pathogenesis of sepsis, cancer, and autoimmune diseases. Recent advances in GSDMD inhibitor development primarily focus on key steps: blocking caspase-mediated cleavage, inhibiting N-terminal oligomerization, or disrupting pore formation. Examples include small-molecule drugs targeting Cys191/192 such as DMF, DSF, NSA, and NU6300, as well as molecules targeting other residues like mafenide, GI-Y1, and GI-Y2. The elucidation of high-resolution structures of caspase-GSDMD complexes and pore assembly mechanisms has facilitated the emergence of novel targeting strategies, providing a critical basis for rational design. Despite progress, challenges such as off-target effects and low clinical translation rates persist. Optimizing specificity and exploring disease-specific applications remain pivotal to advancing these inhibitors as therapeutic agents. Current research focuses on developing clinically translatable, highly effective, and safe GSDMD-targeted therapies through structure-guided optimization, drug repurposing, innovations in precision delivery systems, and synergistic mechanism approaches.
Suppurative chondritis is a potentially devastating complication of burns to the ear. The infection and inflammation can liquify cartilage, leading to significant aesthetic deformities which are difficult to treat. This article reviews published measures for preventing post-burn chondritis. A comprehensive search of all available literature up to September 2020 was performed, according to PRISMA guidelines, for studies assessing preventive measures for post-burn chondritis. Randomised controlled trials (RCT), cohort studies, case-control studies, case reports and series were eligible for inclusion. A total of 10 studies, including one RCT and nine retrospective observational analyses, were included, incorporating 1369 patients with burns to the ear. The most common interventions were pressure avoidance (70%), daily cleansing (60%), topical mafenide acetate (60%) and targeted debridement (30%). Packages of measures which included pressure avoidance were the most effective, all of which achieved a chondritis incidence of <6%. Low-level but strong published evidence suggests that important treatment principles include prevention by pressure relief, targeted debridement, prophylactic local antibiotics, local antisepsis and the avoidance of desiccation.
Recognition of invasive burn wound sepsis as a major cause of morbidity and mortality in burn-injured patients has profoundly changed the management of burn wounds and its associated complications. The development of effective topical antimicrobial therapy is one of the last major developments of modern burn care and has been driven by major world events and scientific breakthroughs. Topical antimicrobial burn care has evolved from the use of anecdotal remedies to scientific breakthroughs such as Moyer's successful dilution of silver nitrate solution, Fox's described benefit of silver sulfadiazine use in animal models, and Pruitt's dramatic improvement in post-burn mortality using topical mafenide acetate in burn wounds. The objective of this manuscript is to review the definition of burn wound sepsis and highlight the major developments and breakthroughs in topical burn wound care throughout history. This includes historical events like major wars or domestic fires that have influenced or impacted the understanding and treatment of burn wounds. Newer advances in topical antimicrobial care such as nanosilvers and dressing technologies that improve the morbidity and mortality associated with burn wound sepsis and novel approaches to management will also be discussed. To improve burn care, it is prudent to look to the past and learn from the experiences of those who contributed to the control of burn wound sepsis.