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Topical Antibiotic Dressing Pregnancy: Use with caution on small areas only

Framycetin Sulfate Gauze (Sofra-Tulle)

Brand names: Sofra-Tulle

Adult dose

Dose: Apply single layer to wound surface; change every 24–48 hours
Route: Topical (wound dressing)
Frequency: Daily to alternate daily
Max: Not for use on large surface areas — systemic aminoglycoside absorption risk
Framycetin (neomycin group aminoglycoside) impregnated paraffin gauze. Active against Gram-negative organisms and S. aureus. Used for superficial burns, skin graft donor sites, and infected wounds. Avoid on large burns — nephrotoxicity and ototoxicity from systemic absorption.

Paediatric dose

Route: Topical
Frequency: Daily to alternate daily
Max: Small wound areas only — more caution in children due to surface area:body weight ratio
Use with caution in neonates and young children — systemic aminoglycoside absorption through large wound areas may cause ototoxicity/nephrotoxicity.

Dose adjustments

Renal

Avoid on large wounds in renal impairment — systemic absorption leads to aminoglycoside accumulation.

Hepatic

No specific adjustment for topical use on small areas.

Clinical pearls

  • Neomycin cross-allergy is common — patch testing recommended if contact dermatitis develops (neomycin is a common patch test allergen)
  • Best suited for small, superficial wounds and split-thickness skin graft donor sites where non-adherence to wound is required
  • For large burns: use silver-based dressings (silver sulfadiazine, Mepilex Ag) instead — no systemic toxicity risk

Contraindications

  • Large burn surface area
  • Renal impairment (large-area use)
  • Auditory nerve damage
  • Known aminoglycoside allergy

Side effects

  • Contact sensitisation (neomycin group — cross-allergy with other aminoglycosides)
  • Systemic aminoglycoside toxicity (large areas — nephrotoxicity, ototoxicity)
  • Local irritation

Interactions

  • Other aminoglycosides (additive systemic toxicity on large wounds)
  • Neuromuscular blocking agents (systemic absorption potentiates block)

Monitoring

  • Wound healing progress
  • Signs of contact sensitisation
  • Renal function if used on large areas

Reference: BNFc; BNF 90; British Burns Association (BBA) Wound Care Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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