Silver sulfadiazine

Silver sulfadiazine cream

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Silver sulfadiazine is an antibiotic intended for topical application to the skin and it acts as a bacteriostatic agent. This drug prevents the growth and reproduction of bacteria, which stops the spread of infection. It is most commonly used to prevent infections in patients suffering from burn injuries (second and third degree burns) and to prevent infections that accompany skin grafts. It is also used in the treatment of pressure sores accompanied by infections.


Patients who are allergic to silver or its salts, should avoid using this drug.

Although this drug is intended only for topical use, there have been reported cases of acute renal failure, which occurred due to the application of this drug to the skin.1 For this reason, Silver sulfadiazine cream should not be used in patients with renal failure.

Cases of erythema multiforme in patients taking this drug have been reported, so it should not be used in patients who already have or have had this skin disease.2

Silver sulfadiazine should not be used in patients who have a rare inherited disorder characterized by a lack of the enzyme called glucose-6-phosphate dehydrogenase. Use of this drug in patients with this hereditary disease, can cause hemolytic anemia (anemia caused by hemolysis-destruction of red blood cells).

Silver sulfadiazine should not be applied in pregnant women with burns that affect less than 20% of the skin.

Silver sulfadiazine should not be used in nursing mothers.

This medicine should be very cautiously applied in patients with hepatic insufficiency. It is necessary to monitor closely kidney and liver function while you are on the treatment with this drug.

Keep in mind that this drug may cause a gray discoloration of the skin (so-called argyria).3 This side effect is more likely to occur if the treated area of the skin is exposed to the sunlight. Argyria do not require interruption of therapy, and quickly disappears after discontinuation of the therapy.

Silver sulfadiazine, pregnancy and breastfeeding

Silver sulfadiazine belongs to sulfonamides (according to its chemical structure) and these compounds are associated with an increased risk of kernicterus in unborn babies and infants, because their liver is not able to metabolize the drug, which causes increased levels of bilirubin in the blood and the occurrence of kernicterus.

Application of this cream during pregnancy and breastfeeding should be avoided.

How to apply

Silver sulfadiazine is commercially available as a 1% cream. Apply a thin layer of cream (approximately 1.5 mm) on the previously cleaned skin, once or twice a day.

If you accidentally remove the cream from the skin, you have to apply the cream again.


Silver sulfadiazine should not be used simultaneously with the following medicines:

  • Oral anticoagulants (e.g. acenocoumarol and warfarin)
  • Oral antidiabetic drugs
  • Antiepileptics (e.g. diphenylhydantoin and phenytoin)
  • Local anesthetics, such as: lidocaine, procaine and benzocaine.
  • Methotrexate (a drug used in the treatment of cancer). Concomitant use of Silver sulfadiazine cream with this drug increases the risk of Methotrexate toxic effects.
  • Cimetidine (a drug used in the treatment of gastric and duodenal ulcers). Co-administration of these two drugs increases the risk of a low white blood cell count (leukopenia).

There are no known interactions with foods and beverages.

Adverse reactions

Adverse reaction of Silver sulfadiazine cream are the following:

  • Allergic reactions accompanied by itching, burning sensation and skin rash (occurs frequently)
  • Leucopenia (low white blood cell count) -occurs frequently
  • Crystalluria (appearance of the crystals in the urine). This side effect is more likely to occur if this cream is applied to the larger areas of the skin
  • Hepatotoxicity
  • Headache
  • Drowsiness
  • Dizziness
  • Ataxia
  • Erythema multiforme
  • Gray discoloration of the skin (argyria)
  • Kernicterus in babies


  1. NCBI link 1
  2. NCBI link 2
  3. NCBI link 3

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