Silver Sulfadiazine Creams/Silver Sulfadiazine is a sulfonamide-based topical agent with antibacterial and antifungal activity. Silver sulfadiazine may act through a combination of the activity of silver and sulfadiazine. When this agent interacts with sodium chloride-containing body fluids, silver ions are released slowly and sustainably into wounded areas. Ionized silver atoms catalyze the formation of disulfide bonds leading to protein structural changes and inactivating thiol-containing enzymes; silver ions may also intercalate DNA thereby interfering with replication and transcription of bacteria. As a competitive inhibitor of para-aminobenzoic acid (PABA), sulfadiazine inhibits bacterial dihydropteroate synthase, thereby resulting in disruption of folic acid metabolism and ultimately DNA synthesis.
Sulfadiazine is a synthetic pyrimidine sulfonamide derivative, short-acting bacteriostatic Sulfadiazine inhibits bacterial folic acid synthesis by competing with para-aminobenzoic acid. It is used in combination with pyrimethamine to treat toxoplasmosis in patients with acquired immunodeficiency syndrome and in newborns with congenital infections.
Sulfadiazine is a sulfonamide antibacterial agent used in the therapy of mild-to-moderate infections due to sensitive organisms. Sulfadiazine, like other sulfonamides, is a well-known cause of clinically apparent, idiosyncratic liver injury.
Synonyms of Silver Sulfadiazine
- Silver sulfadiazinate
- Silver sulfadiazine
- Silver sulphadiazine
- Sulfadiazine silver
- Sulfadiazine silver salt
Mechanism of Action of Silver Sulfadiazine
Studies utilizing radioactive micronized silver sulfadiazine, electron microscopy, and biochemical techniques have revealed that the mechanism of action of silver sulfadiazine on bacteria differs from silver nitrate and sodium sulfadiazine. Silver sulfadiazine acts only on the cell membrane and cell wall to produce its bactericidal effect. A specific mechanism of action has not been determined, but silver sulfadiazine’s effectiveness may possibly be from a synergistic interaction or the action of each component. Silver is a biocide, which binds to a broad range of targets. Silver ions bind to nucleophilic amino acids, as well as sulfhydryl, amino, imidazole, phosphate, and carboxyl groups in proteins, causing protein denaturation and enzyme inhibition. Silver binds to surface membranes and proteins, causing proton leaks in the membrane, leading to cell death. Sulfadiazine is a competitive inhibitor of bacterial para-aminobenzoic acid (PABA), a substrate of the enzyme dihydropteroate synthetase. The inhibited reaction is necessary for these organisms for the synthesis of folic acid.
Indications of Silver Sulfadiazine
- Indicated as an adjunct for the prevention and treatment of wound sepsis in patients with second- and third-degree burns.
- For the treatment of rheumatic fever and meningococcal meningitis
- Burns, External
- Wound Sepsis
- For the treatment of rheumatic fever and meningococcal meningitis
- Sulfadiazine is a sulfonamide antibacterial agent used in the therapy of mild-to-moderate infections due to sensitive organisms. Sulfadiazine, like other sulfonamides, is a well-known cause of clinically apparent, idiosyncratic liver injury.
- As an adjunct for the prevention and treatment of wound sepsis in patients with second and third-degree burns
- Chancroid
- Chlamydial Infections
- Conjunctivitis, Inclusion
- Meningitis caused by Haemophilus influenzae
- Meningococcal Meningitis
- Nocardiosis
- Plague
- Plasmodium Infections
- Toxoplasmosis
- Trachoma
- Urinary Tract Infection
- Wound Sepsis
- Bacterial otitis media caused by Haemophilus influenzae
- Prophylaxis of Rheumatic fever
- Recurrent Rheumatic fever
Contraindications of Silver Sulfadiazine
- is allergic to silver sulfadiazine or to any of the ingredients of the medication
- is a premature infant or newborn in their first month of life
- is currently on sulfonamide therapy
- is pregnant at term
- porphyria
- anemia
- decreased blood platelets
- low levels of white blood cells
- liver problems
- kidney disease with a reduction in kidney function
- pregnancy
- Anemia from Pyruvate Kinase and G6PD Deficiencies
- Allergies to Sulfa (Sulfonamide Antibiotics)
Dosage of Silver Sulfadiazine
Strengths: 1%
Burns – External
- Apply to the affected area 1 to 2 times a day to a thickness of about 1/16 of an inch
Wound Sepsis
- Apply to the affected area 1 to 2 times a day to a thickness of about 1/16 of an inch
Side Effects of Silver Sulfadiazine Creams
The Most Common
- ashen-grey discoloration of the skin
- blistering, peeling, or loosening of the skin
- bloody or cloudy urine
- chills or fever
- cough
- decreased amount of urine or less frequent urination
- increased sensitivity of the skin to sunlight, especially for patients with burns on large areas
- intense itching of burn wounds
- pain at the site of application
- painful or difficult urination
- red skin lesions, often with a purple center
- shortness of breath
- sore throat
- sores, ulcers, or white spots on lips or in mouth
- swollen glands
- unusual bleeding or bruising
- unusual tiredness or weakness
Common
- signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- any mouth sores
- changes in memory and orientation
- cold or flu-like symptoms (such as fever or sore throat)
- confusion
- changes in mood or emotions
- difficulty sleeping or nightmares
- headache
- loss of appetite
- stomach pain
- tiredness or fatigue
- vomiting
- weakness
Rare
- signs of posterior encephalopathy syndrome (e.g., headache, seizures, visual disturbances, altered mental state)
- signs of reduced red blood cells (e.g., fatigue, a general feeling of being unwell, weakness, dizziness, fainting, pale skin, pale stool)
- swelling or tingling in your hands or feet
- symptoms of a urinary tract infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain)
- blistering, peeling, or loosening of the skin
- blue-green to black skin discoloration
- dark urine
- fever with or without chills
- general body swelling
- increased sensitivity of the skin to sunlight, especially in patients with burns on large areas
- intense itching of burn wounds
- light-colored stools
- lower back or side pain
- nausea or vomiting
- pinpoint red spots on the skin
- red skin lesions, often with a purple center
- red, swollen skin
- Blurred vision
- muscle cramps
- numbness or pain in the legs
- ringing in the ears
- sweating
Drug Interactions of Silver Sulfadiazine Creams
Silver Sulfadiazine may interact with following drugs, supplyments & may change the efficacy of drugs
- antidiabetes medications
- cimetidine
- enzymatic debriding agents
- phenytoin
- collagenase topical
- prilocaine
- sodium nitrite
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
- 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 the effects and side effects of some drugs such as vitamin K antagonists.
Pregnancy Category of Silver Sulfadiazine Creams
Pregnancy
The safety of silver sulfadiazine has not been established for use during pregnancy. Silver sulfadiazine should only be used by badly burned pregnant women if the benefits outweigh the risks. Silver sulfadiazine should not be used by a pregnant woman near term.
Breast-feeding
This medication passes into breast milk. If you are a breast-feeding mother and are using silver sulfadiazine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
References
- https://pubchem.ncbi.nlm.nih.gov/compound/Silver-sulfadiazine
- https://pubchem.ncbi.nlm.nih.gov/compound/Sulfadiazine
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