silver sulfadiazine

Therapeutic Classification: anti-infectives (topical)

Pharmacologic Classification: sulfonamides

Indications ⬆ ⬇

REMS

Prevention and treatment of wound sepsis in patients with 2nd- and 3rd-degree burns.

Unlabeled Use:

Management of:
- Minor skin infections,
- Dermal ulcers.

Action ⬆ ⬇

Splits to produce bactericidal concentrations of silver and sulfadiazine.
Action is at level of cell membrane and cell wall.

Therapeutic effects:

Bactericidal action against organisms found in burns.

Spectrum:

Broad spectrum includes activity against many gram-negative and gram-positive bacteria, anaerobes, and some yeast.

Pharmacokinetics ⬆ ⬇

Absorption: Small amounts of silver are systemically absorbed following topical application. Up to 10% of sulfadiazine is absorbed.

Distribution: Unknown.

Metabolism/Excretion: Absorbed sulfadiazine is excreted unchanged by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(anti-infective action)

ROUTE	ONSET	PEAK	DURATION
Topical	on contact	unknown	as long as applied

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (cross-sensitivity with sulfonamides may occur);
Pedi: Infants <2 mo (↑ risk of kernicterus);
OB: Pregnancy near term (↑ risk of kernicterus in infant);
G6PD deficiency;
Porphyria.

Use Cautiously in:

Impaired hepatic or renal function.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: burning, EXFOLIATIVE DERMATITIS, itching, pain, rash, skin discoloration, skin necrosis, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

Hemat: leukopenia

Interactions ⬆ ⬇

Drug-drug:

Silver may inactivate concurrently applied topical proteolytic enzymes (fibrinolysin, desoxyribonuclease).

Route/Dosage ⬆ ⬇

(Adults and Children >1 mo): Apply 1% cream 1–2 times daily in layer 1.5-mm thick.

Availability ⬆ ⬇

(Generic available)

Cream: 1%

Assessment ⬆ ⬇

Assess burned tissue for infection (purulent discharge, excessive moisture, odor, and culture results) and sepsis (WBC, fever, or shock) prior to and throughout course of therapy.
Monitor for hypersensitivity reaction (rash, itching, or burning) at and surrounding sites of application.
Assess patient for skin rash frequently during therapy. Discontinue silver sulfadiazine at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.

Lab Test Considerations:

Monitor renal function studies and CBC periodically when applied to large area; systemic absorption may cause nephritis and reversible leukopenia. Decrease in neutrophil count is greatest 4 days after initiation of therapy; levels usually normalize after 2–3 days.

Implementation ⬆ ⬇

Generally applied after cleansing and debriding of burn wound. Premedicate with analgesic.
Topical Cream is white; discard if it becomes dark.
- Use sterile technique to apply. Cover entire wound at depth of 1.5 mm. Reapply to sites where cream rubs off as a result of patient movement; burn should be coated at all times. Burn may be dressed or kept open, depending on recommendation of health care professional.

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Pronunciation ⬇

Classifications ⬆ ⬇