Silvadene

silver sulfADIAZINE

(sil-ver sul-fa-dye-a-zeen) ,

Dermazin

(trade name),

Flamazine

(trade name),

Flint SSD

(trade name),

Sildimac

(trade name),

Silvadene

(trade name),

Thermazene

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: sulfonamides
Pregnancy Category: B

Indications

Prevention and treatment of wound sepsis in patients with 2nd- and 3rd-degree burns.Management of:
  • Minor skin infections,
  • Dermal ulcers.

Action

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.
Broad spectrum includes activity against many gram-negative and gram-positive bacteria, anaerobes, and some yeast.

Pharmacokinetics

Absorption: Small amounts of silver are systemically absorbed following topical application. Up to 10% of sulfadiazine is absorbed.
Distribution: Unknown.
Metabolism and Excretion: Absorbed sulfadiazine is excreted unchanged by the kidneys.
Half-life: Unknown.

Time/action profile (anti-infective action)

ROUTEONSETPEAKDURATION
Topicalon contactunknownas long as applied

Contraindications/Precautions

Contraindicated in: Hypersensitivity (cross-sensitivity with sulfonamides may occur); Pediatric: Infants <2 mo (↑ risk of kernicterus); Obstetric: Pregnancy near term (↑ risk of kernicterus in infant); G6PD deficiency; Porphyria.
Use Cautiously in: Impaired hepatic or renal function.

Adverse Reactions/Side Effects

Dermatologic

  • exfoliative dermatitis (life-threatening)
  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • burning
  • itching
  • pain
  • rash
  • skin discoloration
  • skin necrosis

Hematologic

  • leukopenia

Interactions

Drug-Drug interaction

Silver may inactivate concurrently applied topical proteolytic enzymes (fibrinolysin, desoxyribonuclease).

Route/Dosage

Topical (Adults and Children >1 mo) Apply 1% cream 1–2 times daily in layer 1.5-mm thick.

Availability (generic available)

Cream: 1%

Nursing implications

Nursing assessment

  • Assess burned tissue for infection (purulent discharge, excessive moisture, odor, and culture results) and sepsis (WBC, fever, or shock) prior to and throughout course of therapy.
  • Monitor for hypersensitivity reaction (rash, itching, or burning) at and surrounding sites of application.
  • Assess patient for skin rash frequently during therapy. Discontinue silver sulfadiazine at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
  • Lab Test Considerations: Monitor renal function studies and CBC periodically when applied to large area; systemic absorption may cause nephritis and reversible leukopenia. Decrease in neutrophil count is greatest 4 days after initiation of therapy; levels usually normalize after 2–3 days.

Potential Nursing Diagnoses

Risk for infection (Indications)
Risk for impaired skin integrity (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Generally applied after cleansing and debriding of burn wound. Premedicate with analgesic.
  • Topical: Cream is white; discard if it becomes dark.
    • Use sterile technique to apply. Cover entire wound at depth of 1.5 mm. Reapply to sites where cream rubs off as a result of patient movement; burn should be coated at all times. Burn may be dressed or kept open, depending on recommendation of health care professional.

Patient/Family Teaching

  • Explain purpose of medication to patient and family. This medication will not stain skin.
  • Advise patient to promptly notify health care provider if rash occurs.

Evaluation/Desired Outcomes

  • Prevention and treatment of infection in 2nd- and 3rd-degree burns. Therapy is continued until burn is healed or skin graft is performed.

Silvadene

trademark for an antibacterial (sulfadiazine silver).
References in periodicals archive ?
With the patient, the laser therapy was used in addition to dilute chlorhexidine soaks, silvadene cream topically, and ceftazidime injections.
Standard care of RadiaPlex gel, Silvadene, and hydrocortisone cream use was allowed.
Silvadene bum cream is great stuff sporting both antimicrobial and anesthetic properties.
Telta Pads and Kerlix Gauze Silvadene Cream Band-Aids Hydrogen Peroxide (it running water is not available)
Postoperative perineal care included conjugated estrogen cream and bacitracin in 34 patients and Silvadene cream in 3 patients, with sitz baths twice daily.
The dressing is used as standard first-line therapy in place of the traditional silvadene antimicrobial cream at the Smith Gate Burn Clinic, the only service in Iraq offering burn care to children.
Additionally, the Iraqi families preferred MEDIHONEY over silvadene -- considered standard of care -- because it was natural and does not need to be changed as often.
The study discovered that the average cost for a traditional Silvadene dressing equated to about $235.
After cleansing, the affected area should be covered with a dressing and a topical antibiotic such as bacitracin, polysporin, or silvadene, which help prevent infection and decrease pain.
These initial results indicated a substantial savings in the time required to heal lesions treated with Collagenase as compared to Silvadene, the standard treatment.