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 infectivesPharmacologic: sulfonamides
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)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Topical | on contact | unknown | as 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.