Silver sulfadiazine

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Silver sulfadiazine
Silver sulfadiazine Silvadene.svg
Systematic (IUPAC) name
Silver [(4-aminophenyl)sulfonyl](pyrimidin-2-yl)azanide
Clinical data
Trade names Silvadene
AHFS/Drugs.com Monograph
MedlinePlus a682598
Pregnancy
category
  • B (not recommended in late pregnancy)
Routes of
administration
Topical
Legal status
Legal status
  • ℞ (Prescription only)
Pharmacokinetic data
Bioavailability <1% (silver), 10% (sulfadiazine)
Protein binding High (silver)
Excretion 2/3 renal (sulfadiazine)
Identifiers
CAS Number 22199-08-2 YesY
ATC code D06BA01 (WHO)
PubChem CID 441244
DrugBank DB05245 YesY
ChemSpider 390017 YesY
UNII W46JY43EJR YesY
KEGG D00433 YesY
ChEBI CHEBI:9142 YesY
ChEMBL CHEMBL1200766 N
Synonyms (4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt
Chemical data
Formula C10H9AgN4O2S
Molar mass 357.14 g/mol
Physical data
Melting point 285 °C (545 °F)
 NYesY (what is this?)  (verify)

Silver sulfadiazine, sold under the brand Silvadene among others, is a topical antibiotic used in partial thickness and full thickness burns to prevent infection.[1]

Common side effects include itching and pain at the site of use. Other side effects include low white blood cell levels, allergic reactions, bluish grey discoloration of the skin, red blood cell breakdown, or liver inflammation. Caution should be used in those allergic to other sulfonamides. It should not be used in pregnant women who are close to delivery. Silver sulfadiazine is not recommended in children less than two months.[2]

Silver sulfadiazine was discovered in the 1960s.[3] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[4] It is available as a generic medication.[2] In the developing world the wholesale cost is between 0.004 and 0.072 USD per gram.[5] In the United States a course of treatment is generally 25 to 50 USD.[6]

Medical uses[edit]

Tentative evidence has found other antibiotics to be more effective and therefore it is no longer generally recommended.[7][8] A Cochrane systematic review from 2013 found that most of the trials had methodological shortcomings and thus are of little use.[7] 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.[7]

Adverse effects[edit]

A non infection related clear fluid may form on the wound's surface. Burning and painful sensations are not uncommon but only temporary.

About 0.1 to 1.0% of people show hypersensitivity reactions such as rashes or erythema multiforme.[11] 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.[11]

Interactions[edit]

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.[11]

Pharmacokinetics[edit]

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.[11]

Names[edit]

Brand names include Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.[12]

See also[edit]

References[edit]

  1. ^ Marx, John; Walls, Ron; Hockberger, Robert (2013). Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences. p. 814. ISBN 1455749877. 
  2. ^ a b "Silver Sulfadiazine". Drugs.com. American Society of Health-System Pharmacists. June 1, 2008. Retrieved 30 August 2016. 
  3. ^ Coran, Arnold G.; Caldamone, Anthony; Adzick, N. Scott; Krummel, Thomas M.; Laberge, Jean-Martin; Shamberger, Robert (2012). Pediatric Surgery (7 ed.). Elsevier Health Sciences. p. 369. ISBN 032309161X. 
  4. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  5. ^ "Silver Sulfadiazine". International Drug Price Indicator Guide. Retrieved 30 August 2016. 
  6. ^ Facep, Hamilton MD Faaem Facmt (2014). Tarascon Pharmacopoeia 2014 Professional Desk Reference Edition. Jones & Bartlett Publishers. p. 157. ISBN 9781284056716. 
  7. ^ a b c Wasiak, J; Cleland, H; Campbell, F; Spinks, A (28 March 2013). "Dressings for superficial and partial thickness burns.". The Cochrane database of systematic reviews. 3: CD002106. doi:10.1002/14651858.CD002106.pub4. PMID 23543513. 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. 
  8. ^ Heyneman, A; Hoeksema, H; Vandekerckhove, D; Pirayesh, A; Monstrey, S (25 April 2016). "The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review.". Burns : journal of the International Society for Burn Injuries. doi:10.1016/j.burns.2016.03.029. PMID 27126813. 
  9. ^ 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. 
  10. ^ 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. 
  11. ^ a b c d Jasek, W, ed. (2007). Austria-Codex (in German). 2 (62 ed.). Vienna: Österreichischer Apothekerverlag. pp. 3270–1. ISBN 978-3-85200-181-4. 
  12. ^ http://www.drugs.com/mtm/ssd.html This source names Silvadene, SSD, SSD AF, Thermazene