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Silver Sulfadiazine (Silvadene)

- Discussion: (see
    - silvadene burn cream is a 1% suspension of silver sulfadiazine in a water soluble base;
    - for prevention and treatment of wound sepsis in patients with second and third degree burns;
    - topical bactercidal agent effective against many gran negative and positive bacteria as well as yeast, however, is absorbed poorly through the eschar site, and is ineffective against enterobacter and pseudomonas;
    - silver sulfadiazine is painless on application (and is often soothing) and causes no acid base abnormalities;
    - silver sulfadiazine is poorly soluble and has only limited ability to penetrate into the burn wound;
           - thus, it is relatively ineffective in controlling bacterial proliferation in the eschar once high bacterial densities have occurred;
    - nearly all enterobacter and pseudomonas will develop resistance;
    - note: resistance to silvadene is mediated by plasmids which may also confer resistance to other antibiotics;

- Dosage:
    - dosage: apply qd to bid to burn area (dressings not required over burn area)

- Cautions:
    - use w/ caution in patients with G6P defficiency (increased risk of hemolysis);
          - ? aspirin is a good screening drug for G6P deficiency;
    - accumulation of the drug may occur in patients with impaired renal or hepatic function;
    - note possible depression myeloid elements in blood and resistance exhibited by certain gram negative bacteria;
          - granulocytopenia typically occurs within the first 5 days after injury
          - the myeloid depression is typically reversable expect when a profound thrombocytopenia accompanies the neutropenia

Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers.

In vivo and in vitro antimicrobial activity of silver sulfadiazine and cerium nitrate.

A Randomized Prospective Study of Topical Antimicrobial Agents on Skin Grafts After Thermal Injury.

Comparison of silver sulphadiazine 1 per cent, silver sulphadiazine 1 % plus chlorhexidine digluconate 0.2 per cent and mafenide acetate 8.5 per cent for topical antibacterial effect in infected full skin thickness rat burn wounds.

Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns.