Silver sulfadiazine, sold under the brand Silvadene among others, is a

topical antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

used in partial thickness and full thickness

burn A burn is an injury to skin, or other tissues, caused by heat, electricity, chemicals, friction, or ionizing radiation (such as sunburn, caused by ultraviolet radiation). Most burns are due to heat from hot fluids (called scalding), soli ...

s to prevent

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

. Tentative evidence has found other antibiotics to be more effective, and therefore it is no longer generally recommended for second-degree (partial-thickness) burns, but is still widely used to protect third-degree (full-thickness) burns. Common side effects include itching and pain at the site of use. Other side effects include low white blood cell levels,

allergic reaction Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

s, bluish grey discoloration of the skin, red blood cell breakdown, or liver inflammation. Caution should be used in those allergic to other

sulfonamides In organic chemistry, the sulfonamide functional group (also spelled sulphonamide) is an organosulfur group with the Chemical structure, structure . It consists of a sulfonyl group () connected to an amine group (). Relatively speaking this gro ...

. It should not be used in

pregnant Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

women who are close to

delivery Delivery may refer to: Biology and medicine *Childbirth *Drug delivery *Gene delivery Business and law *Delivery (commerce), of goods, e.g.: **Pizza delivery ** Milk delivery ** Food delivery ** Online grocer *Deed ("delivery" in contract law), a ...

. It is not recommended for use in children less than two months of age. Silver sulfadiazine was discovered in the 1960s. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...

. It is available as a

generic medication A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active ch ...

. In 2022, it was the 279th most commonly prescribed medication in the United States, with more than 700,000 prescriptions.

Medical uses

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. A Cochrane 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. 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, " hequality of the trials was limited". Cochrane has raised concerns about delays in time to wound healing when SSD is used. 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. 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.

Adverse effects

Application to large areas or to severe burns may lead to systemic absorption and lead to

adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complic ...

similar to those of other

. About 0.1 to 1.0% of people show

hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) is an abnormal physiological condition in which there is an undesirable and adverse immune response to an antigen. It is an abnormality in the immune system that causes Imm ...

reactions such as

rashes A rash is a change of the skin that affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked ...

erythema multiforme Erythema multiforme (EM) is an immune-mediated inflammatory skin condition associated with several viral infections, that appears with red patches evolving into target lesions, typically on both hands. It is typically associated with infection ...

. This reaction is known from other sulfonamides including

antibacterials An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention ...

thiazide Thiazide () refers to both a class of sulfur-containing organic molecules and a class of diuretics based on the chemical structure of benzothiadiazine. The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. The firs ...

diuretic A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics ...

s, and

sulfonylurea Sulfonylureas or sulphonylureas are a class of organic compounds used in medicine and agriculture. The functional group consists of a sulfonyl group (-S(=O)2) with its sulphur atom bonded to a nitrogen atom of a ureylene group (N,N-dehydrourea ...

antidiabetics Drugs used in diabetes treat types of diabetes mellitus by decreasing glucose levels in the blood. With the exception of insulin, most GLP-1 receptor agonists ( liraglutide, exenatide, and others), and pramlintide, all diabetes medications a ...

; but data on the likelihood of cross-allergies are inconsistent. Incorporation of the silver

ion An ion () is an atom or molecule with a net electrical charge. The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by convent ...

s can lead to local

argyria Argyria or argyrosis is a condition caused by excessive exposure to chemical compounds of the element silver, or silver dust. The most dramatic symptom of argyria is that the skin turns blue or blue-gray, and is usually most prominent in sun-ex ...

(discoloration of the skin), especially if the treated area is exposed to

ultraviolet Ultraviolet radiation, also known as simply UV, is electromagnetic radiation of wavelengths of 10–400 nanometers, shorter than that of visible light, but longer than X-rays. UV radiation is present in sunlight and constitutes about 10% of ...

light. Generalised argyria with silver accumulation in kidneys, liver, and

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

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 Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the renal interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules ...

and

anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

Interactions

Protease A protease (also called a peptidase, proteinase, or proteolytic enzyme) is an enzyme that catalysis, catalyzes proteolysis, breaking down proteins into smaller polypeptides or single amino acids, and spurring the formation of new protein products ...

s such as

trypsin Trypsin is an enzyme in the first section of the small intestine that starts the digestion of protein molecules by cutting long chains of amino acids into smaller pieces. It is a serine protease from the PA clan superfamily, found in the dig ...

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 antagonist Vitamin K antagonists (VKA) are a group of substances that reduce blood clotting by reducing the action of vitamin K. The term "vitamin K antagonist" is technically a misnomer, as the drugs do not directly antagonize the action of vitamin K in t ...

Pharmacokinetics

The chemical is poorly soluble, and has only very limited penetration through intact skin. However, contact with body fluids produces free

sulfadiazine Sulfadiazine is an antibiotic. Used together with pyrimethamine, a dihydrofolate reductase inhibitor, it is the treatment of choice for toxoplasmosis, which is caused by a protozoan parasite. It is a second-line treatment for otitis media, pr ...

which can then be systemically absorbed and distributed; it undergoes

glucuronidation Glucuronidation is often involved in drug metabolism of substances such as drugs, pollutants, bilirubin, androgens, estrogens, mineralocorticoids, glucocorticoids, fatty acid derivatives, retinoids, and bile acids. These linkages involve gly ...

in the

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

and is also excreted unaltered in

urine Urine is a liquid by-product of metabolism in humans and many other animals. In placental mammals, urine flows from the Kidney (vertebrates), kidneys through the ureters to the urinary bladder and exits the urethra through the penile meatus (mal ...

. Only when applied to large-area (especially second- and third-degree) burns or other lesions is absorption into the body a problem.

Society and culture

Brand names

Brand names include Silvadene (a

genericized trademark A generic trademark, also known as a genericized trademark or proprietary eponym, is a trademark or brand name that, because of its popularity or significance, has become the generic term for, or synonymous with, a general class of products or ...

), Silverex, Silverol, Silveleb, Silvazine, Flamazine, Thermazene, BurnHeal
Ebermine
Silvozin Tulle Dressing and SSD. This source names Silvadene, SSD, SSD AF, Thermazene

References

{{DEFAULTSORT:Silver Sulfadiazine Silver compounds Sulfonamide antibiotics Antiseptics Drugs developed by Pfizer Pyrimidines World Health Organization essential medicines Wikipedia medicine articles ready to translate