Silver sulfadiazine

Silver sulfadiazine
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)
Legal status
  • ℞ (Prescription only)
Routes of
administration		 Topical
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
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, dermazine, geben, silvadene
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 (INN, or silvadene) is a topical sulfonamide/silver[1] antibacterial used as a topical cream on burns. Evidence regarding its usefulness in burns is poor.[2] 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.[2]

Silver sulfadiazine is typically delivered in a cream or aqueous suspension.

It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[3]

Medical uses

Evidence regarding its usefulness in burns is poor.[2] A 2012 review found that topical silver may worsen healing time compared to controls and showed no evidence of effectiveness in preventing wound infection.[4] A Cochrane systematic review from 2013 found that most of the trials had methodological shortcomings and thus are of little use.[2] 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".[5] Other reviews of the evidence have also concluded, "[the] quality of the trials was limited".[6] Cochrane has raised concerns about delays in time to wound healing when SSD is used.[2]

Adverse effects

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.[7] 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.[7]

Interactions

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.[7]

Pharmacokinetics

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.[7]

Names

Brand names include Silvadene (a genericized trademark), Silverex, Silverol, Silvazine, Flamazine, Thermazene, BurnHeal, and SSD.[8]

See also

References

  1. ↑ 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.
  2. 1 2 3 4 5 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. silver sulphadiazine was consistently associated with poorer healing outcomes
  3. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. 1 2 3 4 Jasek, W, ed. (2007). Austria-Codex (in German) 2 (62 ed.). Vienna: Österreichischer Apothekerverlag. pp. 3270–1. ISBN 978-3-85200-181-4.
  8. ↑ http://www.drugs.com/mtm/ssd.html This source names Silvadene, SSD, SSD AF, Thermazene
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