Silver sulfadiazine
Topical antibacterials
Topical antibacterialsPregnancy: avoid
Avoided when pregnancy is approaching or at term because sulfonamides can raise the risk of kernicterus in the newborn; earlier in pregnancy it is used only if clearly justified.
A silver-sulfonamide cream that keeps deep burns from getting infected. Avoided late in pregnancy and in babies under two months.
Quick facts
- Group
- Topical antibacterials
- Target
- Bacterial cell membrane, cell wall and DNA (silver ions)
- Used for
- Prevention and treatment
- Key effects
- Pain · Transient leukopenia
- Monitor
- Complete blood count · In extensive burns
- ATC
- D06BA01
No doses: the clinician sets them by the current guideline.
Mechanism of action
Silver sulfadiazine is a micronised salt of silver with the sulfonamide sulfadiazine. On the wound it releases silver slowly. Silver acts on the bacterial cell membrane and wall and binds bacterial DNA, killing a broad range of gram-negative bacteria (including Pseudomonas aeruginosa), gram-positive bacteria and yeasts. Its action differs from that of silver nitrate or sulfadiazine alone, and it is active against many bacteria resistant to other antimicrobials.
- The cream slowly releases silver onto the burn
- Silver damages the bacterial membrane, wall and DNA
- Gram-negatives (Pseudomonas), gram-positives and yeasts die
- Less burn-wound sepsis while the burn heals or awaits grafting
Indications
- Prevention and treatment of wound sepsis in second- and third-degree burns, as an adjunct to burn care Burns (thermal, chemical, electrical; inhalation injury) →
Adverse effects
Common
- Pain, burning or itching where it is applied
- Transient leukopenia (low neutrophils) early in treatment
- Skin discolouration and rashes
- Slower separation of the eschar
Contraindications
- Hypersensitivity to silver sulfadiazine or other sulfonamides (possible cross-sensitivity)
- Approaching or at term
- Premature infants and newborns in their first two months (kernicterus)
Key interactions
- Cimetidine
- Leukopenia has been seen more often with the combination.
- Topical proteolytic (debriding) enzymes
- Silver may inactivate the enzymes.
What is monitored
- Complete blood count, looking for leukopenia
- In extensive burns: serum sulfonamide levels, renal function and urine for sulfa crystals
- Signs of wound infection or fungal superinfection
- Skin reactions and signs of haemolysis
Administration and safety
- Applied with sterile technique (sterile gloves) after the burn is cleaned and debrided.
- The burn is kept covered with cream at all times; it is reapplied after hydrotherapy or wherever it has rubbed off. Dressings are optional.
- Treatment continues until healing or until the site is ready for grafting.
Pregnancy and breastfeeding
Avoided when pregnancy is approaching or at term because sulfonamides can raise the risk of kernicterus in the newborn; earlier in pregnancy it is used only if clearly justified.
Nursing care
- Ask about sulfa allergy, G6PD deficiency, liver or kidney disease, and pregnancy before the first application.
- Burn care starts with control of shock and pain; analgesia is planned around dressing changes.
- Follow the blood count and report fever, unusual bleeding or bruising.
- Watch the wound for signs of infection or fungal growth.
Pharmacokinetics
- Absorption
- Absorption grows with the burned area and depth; in extensive burns serum sulfonamide levels can approach therapeutic levels.
- Elimination
- Absorbed sulfadiazine can accumulate when liver or kidney function is impaired.
Test yourself
Think of the answer, then tap the question to see it.
What is silver sulfadiazine used for?
As an adjunct to prevent and treat wound sepsis in second- and third-degree burns.
Which blood change is common early in silver sulfadiazine treatment?
A transient fall in white cells, mainly neutrophils, which usually recovers even if treatment continues.
In which patients is silver sulfadiazine contraindicated because of kernicterus?
Women at or near term, premature infants and newborns in their first two months.
Connections
← Back to the class: Topical antibacterials
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Silver Sulfadiazine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - SILVER SULFADIAZINE cream (DailyMed (U.S. National Library of Medicine), 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.