mafenide
Sources réglementaires consultées
Indications approuvées
- Traitement antibactérien adjuvant des brûlures du deuxième et du troisième degré.
Contre-indications
Absolues
- Hypersensibilité au mafénide ou à l’un des composants.
Mises en garde cliniques
- Mise en garde majeure · L’inhibition de l’anhydrase carbonique peut provoquer une acidose métabolique. Surveiller l’équilibre acido-basique, surtout en cas de brûlures étendues, de dysfonction pulmonaire ou d’insuffisance rénale aiguë. — DailyMed/openFDA, SPL set ID 008eaa23-8f19-4e39-85ff-540c1c834a9e
- Mise en garde majeure · Une anémie hémolytique mortelle et une coagulation intravasculaire disséminée ont été rapportées, notamment en cas de déficit en G6PD. Le sulfite du produit peut provoquer des réactions anaphylactoïdes, surtout chez les personnes asthmatiques. — DailyMed/openFDA, SPL set ID 008eaa23-8f19-4e39-85ff-540c1c834a9e
Effets indésirables
Communs (≥1%)
Douleur ou brûlure au site d’application
Rares mais graves
Anémie hémolytique avec coagulation intravasculaire disséminée · Acidose métabolique
Grossesse et allaitement
Non recommandé chez les femmes en âge de procréer sauf si les brûlures dépassent 20 % de la surface corporelle ou si le bénéfice attendu justifie le risque. Pendant l’allaitement, décider d’arrêter l’allaitement ou le médicament.
Bibliographie récente (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.