silver sulfadiazine (sil-ver sul-fa-dye-a-zeen)
Flamazine, Flint SSD, Sildimac, Silvadene, Thermazene
Therapeutic: anti-infectives (topical)
Prevention and treatment of wound sepsis in patients with 2nd- and 3rd-degree burns. Unlabeled Use: Management of Minor skin infections, Dermal ulcers.
Splits to produce bactericidal concentrations of silver and sulfadiazine. Action is at level of cell membrane and cell wall. Therapeutic Effects: Bactericidal action against organisms found in burns. Spectrum: Broad spectrum includes activity against many gram-negative and gram-positive bacteria, anaerobes, and some yeast.
Adverse Reactions/Side Effects
Derm: burning, itching, pain, rash, skin discoloration, skin necrosis. Hemat: leukopenia.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess the size, depth, color, drainage, and periwound area to document whether drug therapy is successful in decreasing infection and promoting wound healing.
Monitor any new or increased skin reactions at the site of application, including rash, burning, itching, pain, and necrosis. Report any suspicious skin reactions to the physician.
Be alert for signs of leukopenia, including fever, sore throat, and signs of infection. Report these signs to the physician.
Implement wound care procedures (whirlpool, pulsed lavage, gentle débridement) as needed to cleanse burns and ulcers. Make sure the drug is reapplied and dressings are changed according to the recommended procedures.
When indicated, use appropriate physical agents (ultrasound, electric stimulation, ultraviolet light) to facilitate wound healing and augment drug effects.
Check that the patient and family or caregivers understand topical application and wound care procedures and adhere to the recommended dosing schedule.
Instruct patient and family/caregivers about prevention of other types of skin ulcers and the need for visual inspection to prevent recurrence or development of new ulcers.
Absorption: Small amounts of silver are systemically absorbed following topical application. Up to 10% of sulfadiazine is absorbed.
Metabolism and Excretion: Absorbed sulfadiazine is excreted unchanged by the kidneys.
Contraindicated in: Hypersensitivity (cross-sensitivity with sulfonamides may occur); Infants <2 mo (risk of kernicterus); Pregnancy near term (increased risk of kernicterus in infant); G6PD deficiency; Porphyria.
Use Cautiously in: Impaired hepatic or renal function; Children (safety not established).
Drug-Drug: Silver may inactivate concurrently applied topical proteolytic enzymes (fibrinolysin, desoxyribonuclease).
Topical (Adults and Children >1 mo): Apply 1% cream 1–2 times daily in layer 1.5-mm thick.
Availability (generic available)