![]() First of all, it must be stressed that the available evidence is scarce and of low quality. Now let’s focus on superficial burns, undoubtedly its most widespread indication. However, a randomized clinical trial with 86 patients with venous ulcers in which silver sulfadiazine is compared to placebo does not show significant differences in complete healing in the two groups. In the second study, while 29 patients presented infection data on the day treatment began, only 2 had these signs at 6 weeks. With regard to signs of infection, in the first study they were not detected. These series found complete healing in 52 and 40 patients respectively, with loss of follow up of 7 patients in this second group. Two prospective series, with 64 and 70 outpatients each (in German and French respectively), 3 analyse the number of patients with complete healing at 6 weeks of weekly application of silver sulfadiazine cream. However, before we focus on this group of patients, let´s see what has been published on silver sulfadiazine in venous ulcers, as there are many professionals who use it with this indication. Most studies are conducted on splitl-thickness burns. 3 However, these adverse effects are considered rare, so silver sulfadiazine is considered a safe drug. ![]() With the use of silver sulfadiazine severe cutaneous drug reactions have also been described, such as Stevens-Johnson syndrome. In addition to the potential accumulation of silver in different organs, sulfadiazine could produce blood alterations such as methemoglobinemia, haemolysis, leukopenia or hyperbilirubinemia. In order to avoid the possible effects of systemic absorption of silver sulfadiazine, it is necessary to avoid its application in very extensive wounds during prolonged periods of time, especially in patients with renal or hepatic insufficiency. Nitrofurazone is another topical antibiotic widely used in burns and other wounds, which dermatologists know well because it is also responsible for many hypersensitivity reactions. This adverse effect is confirmed by epicutaneous tests (patch test). 2 If a wound worsens after starting treatment with silver sulfadiazine, with increased pain, exudate, and perilesional redness, it may be clinically suspected. 1 Allergic contact dermatitis from silver sulfadiazine, either by allergic reaction to silver or sulfadiazine, is not uncommon. Returning to the specific topic of silver sulfadiazine, harmful effects on healing have been shown in vitro and in vivo, such as altered activation of macrophages and cytotoxicity on keratinocytes and fibroblasts. In chronic wounds, in addition to not having a clear effect on bacteria organized and protected in biofilms, they can produce bacterial resistanceand trigger allergic reactions. In fact, in clean acute wounds, such as those secondary to dermatological procedures, although the use of topical antibiotics is not indicated, it is a very widespread practice (see post: “ How do we manage clean wounds produced after dermatological procedures?“). ![]() ![]() I imagine that many of you will already have the following question in your head…īut is it advisable to apply topical antibiotics on wounds?Īlthough they are commonly used in acute and chronic wounds, the available evidence does not allow us to recommend them. The general recommendation is to apply it daily after cleansing the wound to avoid the formation of a pseudo-scab. Its usual presentation is cream, at a concentration of 1%. In short, it is a mixture of a topical antibiotic with silver. Therefore, when combined in a cream, the bacteriostatic power of sulfadiazine and the silver bactericide effect act in synergy. it prevents the reproduction of bacteria by interfering with their folic acid synthesis. This chemical has a bacteriostatic action, i.e. Sulfadiazine is a type of sulfamide, known traditional broad-spectrum antibacterial(Gram +, Gram – including Pseudomonas, anaerobes). We have already dedicated a post to silver ( “Silver in skin wounds”). Silver sulfadiazine is a combination of silver nitrate and sulfadiazine, so its bacterial effects are due to the action of these two active principles. Although it is a product that I do not use in my clinical practice, its presence in various presentations during the Journées Cicatrisations 2019 has encouraged to dedicate a post to it:) It seems that the opinion of professionals on this product is divided into two camps: supporters and detractors. Silver sulfadiazine cream (better known by its commercial names) remains, since the 70s, in the top of products used in wound healing, predominantly in superficial burns.
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