Silver sulfadiazine

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Silver sulfadiazine
Silver sulfadiazine Structural Formula V1.svg
Clinical data
Trade names Silvadene
Other names(4-Amino-N-2-pyrimidinylbenzenesulfonamidato-NN,01)-silver, sulfadiazine silver, silver (I) sulfadiazine, 4-amino-N-(2-pyrimidinyl)benzenesulfonamide silver salt
AHFS/Drugs.com Monograph
MedlinePlus a682598
Pregnancy
category
  • B (not recommended in late pregnancy)
Routes of
administration
Topical
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability <1% (silver), 10% (sulfadiazine)
Protein binding High (silver)
Excretion 2/3 kidney (sulfadiazine)
Identifiers
  • Silver [(4-aminophenyl)sulfonyl](pyrimidin-2-yl)azanide
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard 100.040.743 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C10H9AgN4O2S
Molar mass 357.14 g·mol−1
3D model (JSmol)
Melting point 285 °C (545 °F)
  • [Ag+].O=S(=O)([N-]c1ncccn1)c2ccc(N)cc2
  • InChI=1S/C10H9N4O2S.Ag/c11-8-2-4-9(5-3-8)17(15,16)14-10-12-6-1-7-13-10;/h1-7H,11H2;/q-1;+1 Yes check.svgY
  • Key:UEJSSZHHYBHCEL-UHFFFAOYSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (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] 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. [2] [3]

Contents

Common side effects include itching and pain at the site of use. [4] Other side effects include low white blood cell levels, allergic reactions, bluish grey discoloration of the skin, red blood cell breakdown, or liver inflammation. [4] Caution should be used in those allergic to other sulfonamides. [4] It should not be used in pregnant women who are close to delivery. [4] It is not recommended for use in children less than two months of age. [4]

Silver sulfadiazine was discovered in the 1960s. [5] It is on the World Health Organization's List of Essential Medicines. [6] It is available as a generic medication. [4]

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. [2] [3] 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. [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". [7] Other reviews of the evidence have also concluded, "[the] quality of the trials was limited". [8] Cochrane has raised concerns about delays in time to wound healing when SSD is used. [2] 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. [9] 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. [9]

Adverse effects

A noninfection-related clear fluid may form on the wound's surface. Burning and painful sensations are not uncommon, but are only temporary.[ citation needed ]

Application to large areas or to severe burns may lead to systemic absorption and lead to adverse effects similar to those of other sulfonamides. [10] 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

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

The chemical is poorly soluble, and has only very limited penetration through intact skin. [11] [12] However, contact with body fluids produces free sulfadiazine which can then be systemically absorbed and distributed; it undergoes glucuronidation in the liver and is also excreted unaltered in urine. [12] Only when applied to large-area (especially second- and third-degree) burns or other lesions is absorption into the body a problem. [11] [12]

Society and culture

Brand names

Brand names include Silvadene (a genericized trademark), Silverex, Silverol, Silveleb, Silvazine, Flamazine, Thermazene, BurnHeal, Ebermine, Silvozin Tulle Dressing and SSD. [13]

Related Research Articles

<span class="mw-page-title-main">Acne</span> Skin condition characterized by pimples

Acne, also known as acne vulgaris, is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily affects skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to lack of confidence, anxiety, reduced self-esteem, and, in extreme cases, depression or thoughts of suicide.

<span class="mw-page-title-main">Scar</span> Area of fibrous tissue that replaces normal skin after an injury

A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.

<span class="mw-page-title-main">Medical uses of silver</span>

The medical uses of silver include its use in wound dressings, creams, and as an antibiotic coating on medical devices. Wound dressings containing silver sulfadiazine or silver nanomaterials may be used to treat external infections. The limited evidence available shows that silver coatings on endotracheal breathing tubes may reduce the incidence of ventilator-associated pneumonia. There is tentative evidence that using silver-alloy indwelling catheters for short-term catheterizing will reduce the risk of catheter-acquired urinary tract infections.

<span class="mw-page-title-main">Burn</span> Injury to flesh or skin, often caused by excessive heat

A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace. In the home, risks are associated with domestic kitchens, including stoves, flames, and hot liquids. In the workplace, risks are associated with fire and chemical and electric burns. Alcoholism and smoking are other risk factors. Burns can also occur as a result of self-harm or violence between people (assault).

<span class="mw-page-title-main">Skin grafting</span> Surgical transplantation of skin

Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft.

ATC code D06Antibiotics and chemotherapeutics for dermatological use is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Subgroup D06 is part of the anatomical group D Dermatologicals.

<span class="mw-page-title-main">Pressure ulcer</span> Skin ulcer (bed sore)

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

<span class="mw-page-title-main">Venous ulcer</span> Medical condition

Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

<span class="mw-page-title-main">Sulfadiazine</span> Chemical compound

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, prophylaxis of rheumatic fever, chancroid, chlamydia, and infections by Haemophilus influenzae. It is also used as adjunct therapy for chloroquine-resistant malaria and several forms of bacterial meningitis. It is taken by mouth. Sulfadiazine is available in multiple generic tablets of 500 mg. For urinary tract infections, the usual dose is 4 to 6 grams daily in 3 to 6 divided doses.

<span class="mw-page-title-main">Skin care</span> Range of practices that support skin integrity

Skin care or skincare is a range of practices that support skin integrity, enhance its appearance, and relieve skin conditions. They can include nutrition, avoidance of excessive sun exposure, and appropriate use of emollients. Practices that enhance appearance include the use of cosmetics, botulinum, exfoliation, fillers, laser resurfacing, microdermabrasion, peels, retinol therapy, and ultrasonic skin treatment. Skin care is a routine daily procedure in many settings, such as skin that is either too dry or too moist, and prevention of dermatitis and prevention of skin injuries.

<span class="mw-page-title-main">Negative-pressure wound therapy</span> Therapeutic technique

Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management started in the 1990s and this technique is often recommended for treatment of a range of wounds including dehisced surgical wounds, closed surgical wounds, open abdominal wounds, open fractures, pressure injuries or pressure ulcers, diabetic foot ulcers, venous insufficiency ulcers, some types of skin grafts, burns, sternal wounds. It may also be considered after a clean surgery in a person who is obese.

A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and depending on the dressing selected, may adhere to the skin, so no separate taping is needed.

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Sulfacetamide is a sulfonamide antibiotic.

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<span class="mw-page-title-main">Diabetic foot</span> Medical condition

A diabetic foot disease is any condition that results directly from peripheral artery disease (PAD) or sensory neuropathy affecting the feet of people living with diabetes. Diabetic foot conditions can be acute or chronic complications of diabetes. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. The resulting bone deformity is known as Charcot foot.

<span class="mw-page-title-main">Diabetic foot ulcer</span> Medical condition

Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It may occur due to a variety of mechanisms. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. It is a major complication of diabetes mellitus, and it is a type of diabetic foot disease. Secondary complications to the ulcer, such as infection of the skin or subcutaneous tissue, bone infection, gangrene or sepsis are possible, often leading to amputation.

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References

  1. Singer AJ, Taira BR, Lee CC (2013). "Thermal Burns". In Marx J, Walls R, Hockberger R (eds.). Rosen's Emergency Medicine - Concepts and Clinical Practice. Elsevier Health Sciences. p. 814. ISBN   978-1455749874. Archived from the original on 13 September 2016.
  2. 1 2 3 4 Wasiak J, Cleland H, Campbell F, Spinks A (March 2013). "Dressings for superficial and partial thickness burns". The Cochrane Database of Systematic Reviews. 2013 (3): CD002106. doi:10.1002/14651858.CD002106.pub4. hdl: 10072/58266 . PMC   7065523 . 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.
  3. 1 2 Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S (November 2016). "The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review". Burns. 42 (7): 1377–1386. doi:10.1016/j.burns.2016.03.029. hdl: 1854/LU-8507323 . PMID   27126813.
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  5. Chung DH, Colon NC, Herndon DN (2012). "Burns". In Coran AG, Caldamone A, Adzick NS, Krummel TM, Laberge J, Shamberger R (eds.). Pediatric Surgery (7 ed.). Elsevier Health Sciences. p. 369. ISBN   978-0323091619. Archived from the original on 13 September 2016.
  6. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  7. Storm-Versloot MN, Vos CG, Ubbink DT, Vermeulen H (March 2010). Storm-Versloot MN (ed.). "Topical silver for preventing wound infection". The Cochrane Database of Systematic Reviews (3): CD006478. doi:10.1002/14651858.CD006478.pub2. PMID   20238345.
  8. Lo SF, Hayter M, Chang CJ, Hu WY, Lee LL (August 2008). "A systematic review of silver-releasing dressings in the management of infected chronic wounds". Journal of Clinical Nursing. 17 (15): 1973–1985. doi:10.1111/j.1365-2702.2007.02264.x. PMID   18705778.
  9. 1 2 Maitz P, Harish B (15 April 2016). "How to Treat: Burns". Australian Doctor. Retrieved 15 November 2017.
  10. "Silver Sulfadiazine". Drugs.com. 2017. Retrieved 16 November 2017.
  11. 1 2 3 4 5 Jasek W, ed. (2007). Austria-Codex (in German). Vol. 2 (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 3270–1. ISBN   978-3-85200-181-4.
  12. 1 2 3 "Silver sulfadiazine - Drug Summary". Prescribers' Digital Reference. 2017. Retrieved 16 November 2017.
  13. "SSD Uses, Side Effects & Warnings". Drugs.com. Archived from the original on 17 April 2011. Retrieved 3 July 2011. This source names Silvadene, SSD, SSD AF, Thermazene