Topical antibacterial (sulfonamide derivative) — deep burn wounds Pregnancy: Use only if essential for life-threatening burns.

Mafenide Acetate 5%

Brand names: Sulfamylon

Adult dose

Dose: Apply to wound surface once or twice daily; for solution (0.5%): continuous soaking

Route: Topical

Frequency: Once or twice daily (5% cream); continuous irrigation (0.5% solution)

Max: Sufficient to cover burn

Deep partial and full-thickness burns: 5% cream once or twice daily. Penetrates eschar better than silver sulfadiazine — preferred for deep burns and where eschar penetration needed. 0.5% solution used for continuous wound irrigation. Specialist burns unit use.

Paediatric dose

Route: Topical

Frequency: Once daily

Max: Specialist guidance

Paediatric burns: same application as adults. Specialist burns unit. Monitor for metabolic acidosis (more common in children with large surface area burns).

Dose adjustments

Renal

Use with caution — metabolite accumulation increases metabolic acidosis risk.

Hepatic

Use with caution in severe hepatic impairment.

Clinical pearls

Penetrates burn eschar — key advantage over silver sulfadiazine for infected deep wounds
Monitor blood gases and acid-base balance when used over large surface areas
More painful on application than silver sulfadiazine — consider analgesia
Specialist burns unit use — not typically used in general surgical wards
Can cause tachypnoea (increased respiratory rate) due to metabolic acidosis

Contraindications

Hypersensitivity to sulfonamides
Pulmonary insufficiency (relative — acidosis can worsen hypoxia)

Side effects

Pain on application (more than silver sulfadiazine)
Metabolic acidosis (carbonic anhydrase inhibition — monitor in large burns)
Hypersensitivity reactions
Tachypnoea (compensatory for metabolic acidosis)

Interactions

No significant systemic drug interactions for topical use

Monitoring

Blood gas (metabolic acidosis)
Wound healing
Pain score

Reference: BNFc; BNF; British Burns Association Guidelines; ABA Burns Treatment Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators