Silver sulfadiazine (INN, or silvadene) is a topical sulfonamide/silver antibacterial used as a topical cream on burns. Studies have found that silver sulfadiazine may increase healing times â€" wounds may take longer to heal if treated with this drug, so it is not recommended by the authors of a Cochrane review.
Silver sulfadiazine is typically delivered in a 1% cream or aqueous suspension. Brand names include 'Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.
It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.
Medical uses
A 2012 review found that topical silver worsens healing time compared to controls and showed no evidence of effectiveness in preventing wound infection. A Cochrane systematic review from 2008 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 and an increased number of dressing applications when SSD is used.
Adverse effects
An aseptic exudate (a 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 patients 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.
See also
- Sulfadiazine
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