Silver sulfadiazine (SSD) is a sulfonamide based topical antibiotic that was commonly used to prevent infection in burns, following skin grafts and for the short term treatment of leg ulcers. The evidence for its use over other treatments is limited. It is most commonly avialable as a 1% cream. Silver sulfadiazine is on the World Health Organization’s List of Essential Medicines.
Silvadene 1% cream (Pfizer)
Mechanism of action:
Acts on the bacterial cell wall and cell membrane, but specific action not clear. Silver sulfadiazine has a broad antimicrobial activity, being bactericidal for many gram-negative and gram-positive bacteria as well as being effective against yeast.
Pharmacokinetics:
Very limited absorption through the skin, but will be greater if applied over a larger area.
Undergoes glucuronidation in the liver as well as excreted unaltered in the urine.
Contraindications:
Hypersensitivity to silver sulfadiazine or any of the other ingredients in the preparation of the cream.
Can increase the possibility of kernicterus, so should not be used in pregnant women close to delivery, in premature infants or in newborn infants
Precautions:
The safe use has not been established in pregnancy or lactation.
Caution if allergy to sulfonamides.
It does slow re-epithelization of wounds, so use should stop when there are signs of healing.
Interactions:
If applied to large areas the action of oral hypoglycemic agents and phenytoin may be increased.
Side Effects:
Most common are a skin rash, itching and pain at the site of application.
Up to 5% may develop a leukopenia.
Flamazine cream
Brand names: Silvadene (Pfizer), Flamazine (Smith & Nephew), Thermazene, BurnHeal, SSD, and others
Chemical formula: C10H9AgN4O2S
Chemical name: Silver 2-(4-aminobenzenesulfonamido)-pyrimidine
Systematic Reviews and Meta Analysis:
Nímia et al (2019):
Other materials (with or without silver) show better results than SSD on outcome wound healing.
SSD and new silver dressings are similar about infection prevention.
Dressings without silver show better rates of infection prevention than SSD.
In Australia, silver sulfadiazine is on the National Podiatry Scheduled Medicines List.
External Links:
Sustained-release silver foam dressings (Podiatry Arena)
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