Mafenide Acetate / Framycetin

How it works

Mafenide is a sulfonamide that diffuses into avascular burn eschar to suppress bacteria there; framycetin is an aminoglycoside that inhibits bacterial protein synthesis. Together they reduce the burn-wound bacterial burden.

Prescribing in practice

• Mafenide inhibits carbonic anhydrase and is absorbed from large burns, so it can cause metabolic acidosis (monitor acid-base balance with extensive use); application can be painful.
• Use caution in sulfonamide allergy (mafenide); framycetin, like other aminoglycosides, risks nephrotoxicity and ototoxicity if substantial amounts are absorbed from large or prolonged applications.
• Topical antimicrobials reduce colonisation but do not replace wound debridement; limit the duration of use to reduce resistance.

Monitoring

Monitor the wound for infection and healing, acid-base status where mafenide is applied to extensive areas, and renal/auditory function with large-area framycetin use.

Counselling the patient

• It is applied to the cleaned burn as directed; mafenide may sting on application.
• Report increasing wound pain, spreading redness, or feeling generally unwell.

Evidence & guidelines

Topical antimicrobials are used within specialist burns protocols to reduce burn-wound infection; choice follows local burns and antimicrobial guidance.