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| Clinical data | |
|---|---|
| Trade names | Silvadene |
| Other names | (4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682598 |
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| Routes of administration | Topical |
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| Legal status | |
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| Pharmacokinetic data | |
| Bioavailability | <1% (silver), 10% (sulfadiazine) |
| Protein binding | High (silver) |
| Excretion | 2/3kidney (sulfadiazine) |
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| CompTox Dashboard(EPA) | |
| ECHA InfoCard | 100.040.743 |
| Chemical and physical data | |
| Formula | C10H9AgN4O2S |
| Molar mass | 357.14 g·mol−1 |
| 3D model (JSmol) | |
| Melting point | 285 °C (545 °F) |
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Silver sulfadiazine, sold under the brandSilvadene among others, is atopical antibiotic used in partial thickness and full thicknessburns to preventinfection.[1] Tentative evidence has found other antibiotics to be more effective, and therefore it is no longer generally recommended forsecond-degree (partial-thickness) burns, but is still widely used to protectthird-degree (full-thickness) burns.[2][3]
Common side effects include itching and pain at the site of use.[4] Other side effects includelow white blood cell levels,allergic reactions,bluish grey discoloration of the skin,red blood cell breakdown, orliver inflammation.[4] Caution should be used in those allergic to othersulfonamides.[4] It should not be used inpregnant women who are close todelivery.[4] It is not recommended for use in children less than two months of age.[4]
Silver sulfadiazine was discovered in the 1960s.[5] It is on theWorld Health Organization's List of Essential Medicines.[6] It is available as ageneric medication.[4] In 2022, it was the 279th most commonly prescribed medication in the United States, with more than 700,000 prescriptions.[7][8]
Tentative evidence has found other antibiotics to be more effective in the healing of superficial and partial thickness burn injuries; therefore, it is no longer generally recommended.[2][3] ACochrane review from 2013 found that most of the trials that met inclusion criteria for the review had methodological shortcomings and thus are of little use in assessing the efficacy of silver sulfadiazine in the healing of burn injuries.[2] 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".[9] Other reviews of the evidence have also concluded, "[the] quality of the trials was limited".[10] Cochrane has raised concerns about delays in time to wound healing when SSD is used.[2] In addition to concerns regarding delayed wound healing, silver sulfadiazine is associated pseudoeschar (a combination of the SSD and congealed exudate) development that makes reassessment of wound depth difficult, and requires daily reapplication.[11] For this reason, application of silver sulfadiazine is not recommended for most burns due to altered wound appearance and the frequency of required dressing changes.[11]
Application to large areas or to severe burns may lead to systemic absorption and lead toadverse effects similar to those of othersulfonamides.[12] About 0.1 to 1.0% of people showhypersensitivity reactions such asrashes orerythema multiforme.[13] This reaction is known from other sulfonamides includingantibacterials,thiazidediuretics, andsulfonylureaantidiabetics; but data on the likelihood of cross-allergies are inconsistent.
Incorporation of the silverions can lead to localargyria (discoloration of the skin), especially if the treated area is exposed toultraviolet light. Generalised argyria with silver accumulation in kidneys, liver, andretina 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 includeinterstitial nephritis andanemia.[13]
Proteases such astrypsin andclostridiopeptidase, 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 asvitamin K antagonists.[13]
The chemical is poorly soluble, and has only very limited penetration through intact skin.[13][14] However, contact with body fluids produces freesulfadiazine which can then be systemically absorbed and distributed; it undergoesglucuronidation in theliver and is also excreted unaltered inurine.[14] Only when applied to large-area (especially second- and third-degree) burns or other lesions is absorption into the body a problem.[13][14]
Brand names include Silvadene (agenericized trademark), Silverex, Silverol, Silveleb, Silvazine, Flamazine, Thermazene, BurnHeal,Ebermine, Silvozin Tulle Dressing and SSD.[15]
It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care.
