Nexobrid is one of the most important drugs in the treatment of deep burns and has recently returned to prominence due to shortages on the Italian market. Used to treat children injured in the Crans-Montana fire, the medicine’s gel and powder are produced by Mediwound and distributed in Italy by MediWound Germany. The active ingredient is bromelain, a proteolytic enzyme derived from the pineapple stem, capable of dissolving damaged tissues (eschar) without affecting healthy ones. This makes it a revolutionary treatment for deep burns.
The problem of shortage
Since 2012 the drug has been authorized in EU countries, but only healthcare personnel trained in specialized centers can use it, due to its highly specific and delicate nature. The Italian Medicines Agency (AIFA) has included Nexobrid in the list of deficient drugs, with the authorization, as early as November 2025, for the importation of foreign analogues to overcome production problems.
For the 2 gram dosage, marketing was definitively stopped in October 2025, while for the 5 gram dosage there were production problems. In these cases, AIFA allows the importation of equivalent drugs approved abroad. The measure concerns extreme situations, when there are no valid alternatives on the Italian market. Approximately 300 drugs out of over 3,000 are in this condition, highlighting the complexity of managing supplies in emergency medicine.
However, alternative options exist, both surgical and pharmacological, such as collagenase or eschar removal surgeries. However, these solutions require more time and, in some cases, anesthesia, but allow burns to still be treated when Nexobrid is not available.
Its use is a hope for the burnt children in Crans-Montana
Nexobrid demonstrated a significant impact on pediatric patients hospitalized after the New Year’s Eve fire in Crans-Montana. The 15 necessary bottles were sent urgently from the Villa Scassi Hospital in Genoa to the Niguarda Major Burns Center in Milan, with a total value of approximately 20,000 euros. The gel acts on eschar, the hard, black crust that forms on burned skin, dissolving necrotic tissues in about 4 hours without compromising healthy ones.
Thanks to this treatment, the need for surgery is avoided, reducing waiting times and the risks of serious infections or sepsis. The simple application, with subsequent washing of the treated area, allows to accelerate recovery and improve the clinical conditions of patients, making Nexobrid a fundamental tool in specialized centers.
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