Trade names Silvadene MedlinePlus a682598 ATC code D06BA01 (WHO) | AHFS/Drugs.com Monograph Routes of
administration Topical | |
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Pregnancy
category B (not recommended in late pregnancy) | ||
Silver sulfadiazine, sold under the brand Silvadene among others, is a topical antibiotic used in partial thickness and full thickness burns to prevent infection. Tentative evidence has found other antibiotics to be more effective and therefore it is no longer generally recommended.
Contents
Common side effects include itching and pain at the site of use. Other side effects include low white blood cell levels, allergic reactions, bluish grey discoloration of the skin, red blood cell breakdown, or liver inflammation. Caution should be used in those allergic to other sulfonamides. It should not be used in pregnant women who are close to delivery. Silver sulfadiazine is not recommended in children less than two months.
Silver sulfadiazine was discovered in the 1960s. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. In the developing world the wholesale cost is between 0.004 and 0.072 USD per gram. In the United States a course of treatment is generally 25 to 50 USD.
Medical uses
Tentative evidence has found other antibiotics to be more effective and therefore it is no longer generally recommended. A Cochrane review from 2013 found that most of the trials had methodological shortcomings and thus are of little use. Another Cochrane systematic review from 2010 concluded, "There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection". Other reviews of the evidence have also concluded, "[the] quality of the trials was limited". Cochrane has raised concerns about delays in time to wound healing when SSD is used.
Adverse effects
A non infection related clear fluid may form on the wound's surface. Burning and painful sensations are not uncommon but only temporary.
About 0.1 to 1.0% of people show hypersensitivity reactions such as rashes or erythema multiforme. This reaction is known from other sulfonamides including antibacterials, thiazide diuretics, and sulfonylurea antidiabetics; but data on the likelihood of cross-allergies are inconsistent.
Incorporation of the silver ions can lead to local argyria (discoloration of the skin), especially if the treated area is exposed to ultraviolet light. Generalised argyria with silver accumulation in kidneys, liver, and retina has only been found in association with excessive long-term use, or repeated use on severe and heavily inflamed burns. Possible consequences of generalised argyria include interstitial nephritis and anemia.
Interactions
Proteases such as trypsin and clostridiopeptidase, which are contained in ointments used for the removal of dead skin on wounds, can be inhibited by silver ions if applied simultaneously. When silver sulfadiazine is absorbed in significant amounts, it can increase effects and side effects of some drugs such as vitamin K antagonists.
Pharmacokinetics
The chemical is poorly soluble, and has only very limited penetration through the skin. Only when applied to large-area burns or other lesions is absorption into the body a problem.
Names
Brand names include Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.