Silver sulfadiazine

Generic Medicine Info
Indications and Dosage
Burn wound infection, Prophylaxis of burn wound infection
Adult: Apply over the affected area to a depth of 3-5 mm 1-2 times daily. Burn site should always be covered with cream, re-apply to areas removed by patient activity. Dressings may be used as necessary.

Fingertip injury
Adult: Upon achievement of injury haemostasis, apply a 3-5 mm layer to the affected area. Conventional finger dressings can be used, or alternatively, a finger of a sterile or plastic glove fixed in place with a waterproof adhesive tape may be used. Change the dressing every 2-3 days.

Infected leg ulcers, Infected pressure ulcers
Adult: For short-term treatment: Fill ulcer cavity to a depth of at least 3-5 mm daily; less frequent changes may be done (48 hourly) for less exudative wounds. Follow cream application with an absorbent pad or gauze dressing, with further application of pressure bandaging suitable for the ulcer.
Hypersensitivity. Premature infants or neonates (≤2 months). Pregnancy (near or at term).
Special Precautions
Patient with hypersensitivity to sulfonamide-derived medicines, G6PD deficiency. Not recommended for use in very exudative leg or pressure ulcers. Hepatic and renal impairment. Lactation.
Adverse Reactions
Significant: Fungal or bacterial superinfection including C.difficile-associated diarrhoea (CDAD) and pseudomembranous colitis, leucopenia (prolonged use); delayed eschar separation. Rarely, fungal proliferation.
General disorders and administration site conditions: Application site burning
Immune system disorders: Hypersensitivity reactions.
Skin and subcutaneous tissue disorders: Pruritus, rash, eczema, contact dermatitis, erythema multiforme, skin discolouration, photosensitivity. Rarely, Argyria (prolonged use/large area of application).
Potentially Fatal: Stevens-Johnson syndrome.
Topical: B (Silver sulfadiazine is not recommended during near term pregnancy due to the potential risk of neonatal hyperbilirubinaemia and kernicterus.)
Monitoring Parameters
Perform urinalysis, renal function tests, CBC (patient with extensive burns and on long-term treatment). Monitor serum electrolytes; serum sulfa concentrations (as necessary).
Drug Interactions
May inactivate enzymatic debriding agents. May alter the effects of oral hypoglycaemic agents and phenytoin (application in large areas).
Mechanism of Action: Silver sulfadiazine is a sulfonamide with broad antimicrobial activity that acts upon the bacterial cell wall and cell membrane of Gram-positive and Gram-negative organisms and even yeasts.
Absorption: Up to approx 10% of sulfadiazine and some silver may be absorbed; depending on the nature of the wound and treatment regimen.
Excretion: Silver: Slowly excreted via the faeces; Sulfadiazine: Via urine (6.6% within 5 days).
Chemical Structure

Chemical Structure Image
Silver sulfadiazine

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 441244, Silver sulfadiazine. Accessed Jan. 26, 2021.

Store between 20-25°C. Protect from light.
MIMS Class
Topical Antibiotics
ATC Classification
D06BA01 - silver sulfadiazine ; Belongs to the class of topical sulfonamides used in the treatment of dermatological diseases.
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Anon. Silver Sulfadiazine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 20/11/2020.

Buckingham R (ed). Sulfadiazine Silver. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. Accessed 20/11/2020.

Dermazin (Salutas Pharma GmbH). MIMS Hong Kong. Accessed 20/11/2020.

Flamazine Cream 1.0%w/w (Smith & Nephew Pharmaceuticals Ltd.). MHRA. Accessed 20/11/2020.

Joint Formulary Committee. Silver Sulfadiazine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. Accessed 20/11/2020.

Silvadene Cream (Pfizer Laboratories Div Pfizer Inc). DailyMed. Source: U.S. National Library of Medicine. Accessed 20/11/2020.

Silvedex 10 mg/g (1% w/w) Cream (S Kant Healthcare Ltd.). MIMS Philippines. Accessed 20/11/2020.

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