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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Mafenide is a sulfonamide-type topical medication used to treat severe burns. It acts by reducing the bacterial population present in the burn tissue, with particular efficacy against Pseudomonas aeruginosa, and is said to promote healing of deep burns. In pharmaceutical products, mafenide is employed as mafenide acetate (CAS number 13009-99-9, EC number 235-855-0, molecular formula C9H14N2O4S) (1).
Sulfonamides
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Natasha E. Holmes, M. Lindsay Grayson
Certain sulfonamides applied topically are of benefit in the management of burns. Mafenide (sulfamylon) was used in Germany for the topical therapy of war wounds in the 1940s. Because this topical therapy was effective in suppressing P. aeruginosa infection in burned rats, it was used with similar results for the treatment of burns in humans (Lindberg et al., 1965). Many studies have since confirmed that an 11.2% cream of mafenide can significantly reduce sepsis in burned patients (Lowbury et al., 1971; Pegg, 1972). These applications are usually painful, and mafenide is absorbed through burned areas. Mafenide and its breakdown products are strong acids and also carbonic anhydrase inhibitors, so that if large quantities of the drug are used, metabolic acidosis may result, but this is usually compensated for by hyperventilation (Pegg, 1972). Silver nitrate in a 0.5% solution was another popular topical application for burned patients (Lowbury et al., 1971). Mafenide 5% was compared with 10% povidone, 0.25% sodium hypochlorite, 3% hydrogen peroxide, and 0.25% acetic acid in the management of contaminated wounds (Bennett et al., 2001). Mafenide was superior in maintaining an aseptic environment and increasing angiogenesis, fibroblast proliferation, and dermal thickness. Topical 5% mafenide also inhibits DNA and protein synthesis in wounds (Zhang et al., 2006). Mafenide 2.5% has been used in a pediatric burn hospital without increased rates of bacteremia or wound infection compared with mafenide 5% (Ibrahim et al., 2014).
Complications of Thermal Injuries
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Mark Cockburn, Edgar J. Pierre, Mark G. McKenney
Sulfamylon® (mafenide acetate 0.5% cream), introduced in the mid-1960s, is readily absorbed through burn eschar. It is available in both a 10% water-soluble cream and a 5% solution. It has a wide antibacterial spectrum against most gram-positive bacteria, including Clostridia, and most gram-negative bacteria [6,11]. Cutaneous hypersensitivity reactions may be seen in as many as 50% of patients. Mafenide is a potent carbonic anhydrase inhibitor, and its use can result in metabolic acidosis. A compensatory hyperventilation may occur; minute ventilation as high as 50 L has been reported [9]. Consequently, when mafenide is used, the patient’s respiratory status, pH levels, and blood gases must be frequently monitored. In burn patients with inhalation injury and concomitant respiratory acidosis, the use of mafenide acetate over a large burn surface area or repeated application of this compound can be fatal [7]. Mafenide acetate also decreases the breaking strength of healed wounds and delays healing [13]. Because of its ability to inhibit human keratinocytes and fibroblasts in vitro and to suppress the activity of polymorphonuclear leukocytes (PMNs) and lymphocytes, mafenide inhibits re-epithelialization more than SSD does [11].
Prevention and treatment of burn wound infections: the role of topical antimicrobials
Published in Expert Review of Anti-infective Therapy, 2022
Deepak K. Ozhathil, Steven E. Wolf
Despite its benefits, application is painful and poorly received by patients. Also, similar to silver sulfadiazine, mafenide acetate has deleterious effects on keratinocytes and inhibits leukocyte activity, which impairs wound healing and decreases the tensile strength of the scar [43,53]. In addition, monoamide oxidase (MAO) coverts mafenide acetate to p-sulfamylvanzoic acid, which is a carbonic anhydrase inhibitor and causes metabolic acidosis and compensatory respiratory alkalosis [54]. This is particularly concerning in patients with inhalation injuries because metabolic acidosis compounds chemical hypoxia and respiratory acidosis caused by inhalation of combustion byproducts [54,55]. Lastly, mafenide acetate is contraindicated in in patients with a sulfa drug allergy. Summary: The primary use of mafenide acetate cream in burn centers today is for burn wounds on the nose and ears to minimize the risk of invasive chondritis. Because it impairs wound healing, mafenide acetate cream is not appropriate for general use on partial thickness burns. However, because it has excellent eschar penetration and gram-negative coverage, it may be considered for full thickness burns in patients who are not appropriate operative candidates.
Acquired methemoglobinemia after hydroxocobalamin administration in a patient with burns and inhalation injury
Published in Clinical Toxicology, 2018
Alisha Z. Jiwani, Vikhyat S. Bebarta, Leopoldo C. Cancio
We did not identify another methemoglobinemia-inducing toxic exposure or other pre-existing genetic or medical condition. We considered mafenide acetate as a potential cause of methemoglobinemia. Topical mafenide is known to induce acute methemoglobinemia within 30 minutes of application [5]. It was excluded as a causative agent, however, because our patient developed methemoglobinemia 12 hours after initial application.