|Systematic (IUPAC) name|
|Bioavailability||<1% (silver), 10% (sulfadiazine)|
|Protein binding||High (silver)|
|Excretion||2/3 renal (sulfadiazine)|
|Synonyms||(4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt, dermazine, geben, silvadene|
|Melting point||285 °C (545 °F)|
|(what is this?)|
Silver sulfadiazine (INN, or silvadene) is a topical sulfonamide/silver antibacterial used as a topical cream on burns. Evidence regarding its usefulness in burns is poor. Tentative evidence has found that silver sulfadiazine may increase healing times – wounds may take longer to heal if treated with this drug, so it is not recommended by the authors of a Cochrane review.
Silver sulfadiazine is typically delivered in a 1% cream or aqueous suspension. Brand names include 'Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.
It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.
Evidence regarding its usefulness in burns is poor. A 2012 review found that topical silver may worsen healing time compared to controls and showed no evidence of effectiveness in preventing wound infection. A Cochrane systematic review from 2008 found that most of the trials had methodological shortcomings and thus are of little use. 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, "[the] quality of the trials was limited". Cochrane has raised concerns about delays in time to wound healing and an increased number of dressing applications when SSD is used.
About 0.1 to 1.0% of patients show hypersensitivity reactions such as rashes or erythema multiforme. This reaction is known from other sulfonamides including antibacterials, thiazide diuretics, and sulfonylurea antidiabetics; but data on the likelihood of cross-allergies are inconsistent.
Incorporation of the silver ions can lead to local argyria (discoloration of the skin), especially if the treated area is exposed to ultraviolet light. Generalised argyria with silver accumulation in kidneys, liver, and retina 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 and anemia.
Proteases such as trypsin 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 antagonists.
The chemical is poorly soluble, and has only very limited penetration through the skin. Only when applied to large-area burns or other lesions is absorption into the body a problem.
- Fisher NM, Marsh E, Lazova R (October 2003). "Scar-localized argyria secondary to silver sulfadiazine cream". J. Am. Acad. Dermatol. 49 (4): 730–2. doi:10.1067/S0190-9622(02)61574-9. PMID 14512929.
- Wasiak J, Cleland H, Campbell F (2008). "Dressings for superficial and partial thickness burns". Cochrane Database Syst Rev (4): CD002106. doi:10.1002/14651858.CD002106.pub3. PMID 18843629.
The use of silver sulphadiazine (SSD) as a comparator on burn wounds for the full duration of treatment needs to be reconsidered, as a number of studies showed delays in time to wound healing and increased number of dressing applications in patients treated with SSD dressings
- http://www.drugs.com/mtm/ssd.html This source names Silvadene, SSD, SSD AF, Thermazene
- "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
- Aziz, Z; Abu, SF; Chong, NJ (May 2012). "A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds.". Burns : journal of the International Society for Burn Injuries 38 (3): 307–18. doi:10.1016/j.burns.2011.09.020. PMID 22030441.
- Storm-Versloot, MN; Vos, CG; Ubbink, DT; Vermeulen, H (Mar 17, 2010). Storm-Versloot, Marja N, ed. "Topical silver for preventing wound infection". Cochrane database of systematic reviews (Online) (3): CD006478. doi:10.1002/14651858.CD006478.pub2. PMID 20238345.
- Lo SF, Hayter M, Chang CJ, Hu WY, Lee LL (2008). "A systematic review of silver-releasing dressings in the management of infected chronic wounds". Journal of clinical nursing 17 (15): 1973–85. doi:10.1111/j.1365-2702.2007.02264.x. PMID 18705778.
- Jasek, W, ed. (2007). Austria-Codex (in German) 2 (62 ed.). Vienna: Österreichischer Apothekerverlag. pp. 3270–1. ISBN 978-3-85200-181-4.