MAFENIDE ACETATE

MAFENIDE ACETATE
(ma'fe-nide)
Sulfamylon
Classifications: antibiotic; sulfonamide derivative;
Therapeutic:antibiotic

Prototype: Sulfisoxazole
Pregnancy Category: C

Availability

5% solution; cream

Action

Topical sulfonamide derivative effective against both gram-positive and gram-negative drugs. Topical applications produce marked reduction of bacterial growth in vascular tissue. Active in presence of purulent matter and serum and not affected by changes in pH of tissue environment.

Therapeutic Effect

Bacteriostatic against many gram-positive and gram-negative organisms, including Pseudomonas aeruginosa, and certain strains of anaerobes.

Uses

Adjunctive therapy in second- and third-degree burns to prevent sepsis.

Contraindications

History of hypersensitivity to mafenide; respiratory (inhalation) injury, pulmonary infection; pregnancy (category C), lactation, children <3 mo.

Cautious Use

Impaired kidney or pulmonary function, burn patients with acute kidney failure.

Route & Dosage

Burns
Adult: Topical Apply aseptically to burn areas to a thickness of approximately 15 mm (1/16 in) once or twice daily

Administration

Topical
  • Apply cream or solution aseptically to cleansed, debrided burn areas with sterile gloved hand.
  • Cover burn areas with cream at all times. Make reapplications to areas from which cream has been removed as necessary.
  • Store in tight, light-resistant containers. Avoid extremes of temperature.

Adverse Effects (≥1%)

Hypersensitivity: Pruritus, rash, urticaria, blisters, facial edema, eosinophilia. Skin: Intense pain, burning, or stinging at application sites, bleeding of skin, excessive body water loss, delayed eschar separation, excoriation of new skin, superinfections. Hematologic: Hemolytic anemia, bone marrow suppression (rare). Other: Metabolic acidosis.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Absorption: Rapidly from burn surface. Peak: 2–4 h. Metabolism: Rapidly inactivated in blood to a weak carbonic anhydrase inhibitor. Elimination: Via kidneys.

Nursing Implications

Assessment & Drug Effects

  • Monitor vital signs. Report immediately changes in BP, pulse, and respiratory rate and volume.
  • Monitor I&O. Report oliguria or changes in I&O ratio and pattern.
  • Lab tests: Monitor fluid and electrolyte status throughout therapy; acid–base balance should be monitored in patients with extensive burns and in those with pulmonary or kidney dysfunction.
  • Be alert to S&S of metabolic acidosis (see Appendix F).
  • Be alert to evidence of superinfections (see Appendix F), particularly in and below burn eschar.
  • Observe carefully; accuracy is critical. It is frequently difficult to distinguish between adverse reactions to mafenide and the effects of severe burns.
  • Note: Allergic reactions have reportedly occurred 10–14 d after initiation of mafenide therapy. Temporary discontinuation of drug may be necessary.
  • Report intense local pain to physician; pain caused by drug may require administration of analgesic.

Patient & Family Education

  • Apply only a thin dressing over burns unless otherwise directed.
  • Therapy is usually continued until healing is progressing well (usually 60 d) or site is ready for grafting (after about 35–40 d). It is not withdrawn while there is a possibility of infection unless adverse reactions intervene.
  • Report any of the following to the physician immediately: Foul-smelling drainage from wounds, bleeding at wound site, unexplained fever.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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