Silver Sulfadiazine

About Silver Sulfadiazine

Silver sulfadiazine is a sulfa drug that kills many kinds of bacteria and is also active against yeast, and it is labeled as an adjunct to prevent and treat wound sepsis in second and third degree burns. After the burn is cleaned and dead tissue removed, the cream is applied under sterile conditions once or twice a day to a thickness of about 1/16 inch, and the burn is kept covered with cream at all times, with more added wherever it rubs off and right after hydrotherapy; dressings are optional. Treatment continues until the burn has healed well or is ready for grafting, and it is not stopped while infection is still possible unless a significant reaction occurs.

It is contraindicated near term in pregnancy, in premature infants and in newborns during their first two months, because sulfonamides may increase the risk of kernicterus, and in anyone allergic to silver sulfadiazine or another ingredient. Cross-sensitivity with other sulfa drugs is possible, and the label warns of the serious reactions seen with sulfonamides, including blood disorders, severe skin reactions such as Stevens-Johnson syndrome, hepatitis and kidney damage. People with G6PD deficiency can develop hemolysis (destruction of red blood cells). Temporary falls in white blood cells have been reported, deepest within two to four days of starting and recovering within two to three days even if treatment continues; skin necrosis, erythema multiforme, skin discoloration, burning, rashes and interstitial nephritis occur infrequently.

With extensive burns, enough sulfadiazine can be absorbed that blood sulfa levels, kidney function and the urine are checked, and liver or kidney disease can slow its clearance. Fungi can grow in and under the burn crust (eschar), and because the cream slows bacterial growth the eschar may separate later, sometimes needing it to be cut (escharotomy) to prevent contracture. The silver can inactivate enzyme products used to clean wounds, and cimetidine has been linked with more frequent low white cell counts. Earlier in pregnancy it is used only if clearly justified, and because sulfonamides pass into breast milk, the prescriber weighs nursing against treatment. Drugs@FDA lists Silvadene, SSD and Thermazene as separately approved products rated equivalent to one another, and SSD AF as discontinued.

Taking Silver Sulfadiazine

How to take it

Wear a sterile disposable glove to apply it. Clean the burn as directed, then spread a layer about 1/16 inch thick once or twice a day so the burn stays covered, reapplying wherever it comes off; gently wash the burned skin daily to help remove dead skin, and use a dressing only if the prescriber says to.

If you miss a dose

Apply it as soon as you remember, unless the next application is nearly due; then skip the missed one, and do not apply extra.

Storage

At room temperature in the closed container, away from heat and moisture and out of reach of children. Use a take-back program rather than flushing.

Interactions to know about

It can inactivate enzyme products used to clean burns, and cimetidine has been linked with more frequent low white cell counts; tell the prescriber about kidney or liver disease. Call promptly for fever, sore throat, unusual bruising or bleeding, yellow skin or eyes, blood in the urine, aching joints, unusual tiredness or a rash.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Silver Sulfadiazine differs from pharmacy to pharmacy

Silver sulfadiazine is an old product made under three approvals rated equivalent to one another, so a prescription that allows substitution can be filled with whichever one the pharmacy stocks, and quotes differ mainly in each pharmacy’s dispensing fee and markup.

The size written matters a great deal: tubes run from 20 to 85 g and jars from 50 to 1,000 g, and a burn that must stay covered with cream, reapplied once or twice a day, can use a large amount, so the size and number of containers written change the total.

Ways to pay less for Silver Sulfadiazine without insurance

• Ask for whichever rated-equivalent cream the pharmacy stocks, and if the prescription names Silvadene, check that it allows substitution.
• Ask the prescriber to write the size that matches the burn’s area and the expected length of treatment, and ask the pharmacy to quote both a jar and tubes.
• Compare more than one pharmacy.
• Mention a sulfa allergy or G6PD deficiency before the prescription is filled, so the prescriber can choose another treatment if needed.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Silver Sulfadiazine

1. 1.How thick a layer do I apply, and how often should I reapply it?
2. 2.Is it safe with my sulfa allergy or G6PD deficiency?
3. 3.Will I need blood or kidney tests while I use it on a large burn?
4. 4.Can I use it on my baby, or while I am pregnant or breastfeeding?

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