Silvadene

Topical Sulfonamides

Silver sulfadiazine is for external use only.
Do not use if cream has darkened in color.
Apply to cleansed, debrided, burned areas using a sterile-gloved hand. Apply to a thickness of approx. = 1.6 mm (1/16th of an inch).
Dressings usually are not required, but may be used.
Treatment is normally continued until the site is ready for grafting or until satisfactory healing occurs. Unless a significant adverse reaction occurs, do not stop treatment while the threat of infection remains.

exfoliative dermatitis / Delayed / 1.0-10.0
skin necrosis / Early / 1.0-10.0
erythema multiforme / Delayed / 1.0-10.0
Stevens-Johnson syndrome / Delayed / 0-1.0
toxic epidermal necrolysis / Delayed / 0-1.0
agranulocytosis / Delayed / 0-1.0
hepatic necrosis / Delayed / 0-1.0
hemolytic anemia / Delayed / 0-1.0
aplastic anemia / Delayed / 0-1.0
interstitial nephritis / Delayed / 0-1.0

hepatitis / Delayed / 0-1.0
thrombocytopenia / Delayed / 0-1.0
superinfection / Delayed / 0-1.0
leukopenia / Delayed / Incidence not known
hemolysis / Early / Incidence not known

pruritus / Rapid / 1.0-10.0
rash / Early / 1.0-10.0
skin discoloration / Delayed / 1.0-10.0
photosensitivity / Delayed / Incidence not known

Silvadene, SSD, SSD AF, Thermazene

Rx

Topical sulfonamide antiinfective; wide spectrum of activity against Candida and gram-positive and gram-negative bacteria; used to prevent and treat serious burn and wound infections.

Apply a thickness of approximately one-sixteenth inch to the affected area(s) topically once or twice daily until healing has occurred or the wound is ready for grafting; reapply as necessary if removed by activity or hydrotherapy.

Apply a thickness of approximately one-sixteenth inch to the affected area(s) topically once or twice daily until healing has occurred or the wound is ready for grafting; reapply as necessary if removed by activity or hydrotherapy.

Sulfonamides may cause hepatic impairment; use with caution in hepatic disease. Discontinuation of treatment may be needed if hepatic impairment occurs with treatment.

Sulfadiazine may accumulate with renal impairment. Accumulation will depend on the body surface area involved and the extent of tissue damage.

Collagenase: (Contraindicated) Silver sulfadiazine should not be used with the proteolytic enzymes collagenase, papain, or sutilains because heavy metals such as silver inactivate these enzymes.
Keratinocytes; Fibroblasts; Collagen: (Major) Avoid the use of silver-containing antimicrobials or dressing (such as silver sulfadiazine) in patients receiving treatment with keratinocytes and dermal fibroblast collagen. Administering these drugs together may reduce wound repair and regeneration. In vitro data suggest silver may decrease the viability of keratinocytes and human dermal fibroblasts.
Sulfacetamide: (Major) Topical and ophthalmic sulfonamides are incompatible with preparations containing silver. Sulfacetamide sodium should not be applied to the same sites as products containing silver salts, including preparations such as silver nitrate, silver sulfadiazine, or mild silver protein.
Sulfacetamide; Sulfur: (Major) Topical and ophthalmic sulfonamides are incompatible with preparations containing silver. Sulfacetamide sodium should not be applied to the same sites as products containing silver salts, including preparations such as silver nitrate, silver sulfadiazine, or mild silver protein.

Silvadene/Silver/Silver Sulfadiazine/SSD/SSD AF/Thermazene Topical Cream: 1%

2 applications/day; additional applications may be necessary if cream is removed by activity.

2 applications/day; additional applications may be necessary if cream is removed by activity.

2 applications/day; additional applications may be necessary if cream is removed by activity.

2 applications/day; additional applications may be necessary if cream is removed by activity.

>= 2 months: 2 applications/day; additional applications may be necessary if cream is removed by activity.

< 2 months: Safety and efficacy have not been established.

Mechanism of Action: The exact mechanism by which silver sulfadiazine exerts its antiinfective activity is unknown. Both free silver and the sulfonamide moiety may exert activity, but the drug does not inhibit folic acid synthesis as other sulfonamides do. Silver sulfadiazine disrupts bacteria by damaging the cell membrane and the cell wall rather than by inhibiting folic acid synthesis.Silver sulfadiazine has a wide spectrum of bactericidal activity against both gram-positive and gram-negative organisms. Organisms that are susceptible to topical silver sulfadiazine include Staphylococcus aureus, S. epidermidis, beta-hemolytic streptococci, Klebsiella, Escherichia coli, Enterobacter (including E. cloacae), Citrobacter, Proteus, Pseudomonas, Morganella morganii, Providencia, Serratia, and Candida albicans.

Silver sulfadiazine is administered topically. Once absorbed, sulfadiazine is distributed into most body tissues, and it appears to freely cross cell membranes. Sulfadiazine is metabolized by the liver to an N[23464]-acetyl derivative, glucuronide, and other metabolites, which are then excreted in the urine along with unchanged drug. Within 72 hours, 60—80% of the absorbed drug can be collected in the urine either as metabolites or unchanged drug.

Silver sulfadiazine is not absorbed through intact skin. In contact with body fluids, it is converted by sulfhydryl groups and proteins to free sulfadiazine, which can be systemically absorbed, especially when applied to second- or third-degree burns. Systemic concentrations of sulfadiazine are detectable in some patients. Roughly 10% of sulfadiazine can be absorbed, while only 1% of free silver is absorbed. In the treatment of patients with extensive body surface area involvement, serum sulfa concentrations may reach therapeutic levels (8—12 mcg/ml).

Silver sulfadiazine is classified in FDA pregnancy category B. According to the manufacturer, it is contraindicated in near-term pregnancy because sulfonamides may promote kernicterus in the newborn by displacing bilirubin from plasma proteins. Sulfonamides can displace bilirubin from protein binding sites and theoretically precipitate kernicterus in newborns. While this adverse reaction has occurred when a sulfonamide was administered directly to the newborn, it has not been demonstrated in a newborn when exposed to the drug in utero. Since silver sulfadiazine is administered topically, it seems even less likely than systemically administered sulfonamides to invoke this adverse reaction. Nevertheless, sulfonamides should be used with caution during near term pregnancy because of the potential risk of causing kernicterus in newborns.

According to the manufacturer, because of the possibility for serious adverse reactions in nursing infants from sulfonamides, silver sulfadiazine should not be used during breast-feeding. It is not known whether it is excreted in human milk. However, sulfonamides are known to be excreted in human milk, and all sulfonamide derivatives are known to increase the possibility of kernicterus. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.