[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Topical antibacterials](https://durgical.com/en/pharmacology/classes/topical-antibacterials/) › Silver sulfadiazine

# Silver sulfadiazine

## Topical antibacterials?

Topical antibacterials

## Pregnancy: 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Topical antibacterials](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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) →](https://durgical.com/en/conditions/burns/)

## 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

### Serious (rare, important)

- Sulfonamide reactions: agranulocytosis, aplastic anaemia, thrombocytopenia, haemolytic anaemia
- Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
- Haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficiency
- Hepatitis, interstitial nephritis and toxic nephrosis
- Fungal growth in and under the eschar; argyria (grey skin) after use over very large areas

## 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.

## Memory aid

SILVER for burns: Sulfa allergy? Infants under two months? Leukopenia, Very late pregnancy, Eschar slow to separate, Renal and liver checks.

## 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.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**Pregnancy: 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.

## Connections

## Related drugs 1

- [Mupirocin](https://durgical.com/en/pharmacology/mupirocin/)

## Related conditions 1

- [Burns (thermal, chemical, electrical; inhalation injury)](https://durgical.com/en/conditions/burns/)

[← Back to the class: Topical antibacterials](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a682598.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - SILVER SULFADIAZINE cream](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4d6694f-2b0a-4d64-9e05-2fef6d8e60d9) (DailyMed (U.S. National Library of Medicine), 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=silver%20sulfadiazine) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/silver-sulfadiazine/