Nitrous Acid
Severe
Database
Clinical effect not specified
Source: DDInter
Drug reference
silver sulfadiazine
Topical antibacterial (sulfonamide–silver complex) · Topical antibacterial
START
Apply 1% cream 1.5–3 mm thick once–twice daily
TYPICAL MAX
Topical to burn area 1–2 times daily
STOP IF
Severe skin reaction, leukopenia, or systemic sulfonamide toxicity
WATCH
CBC if large area, signs of SJS; avoid in neonates/sulfa allergy
CDSCO approvedATC D06BA01
KDIGO 2024 + manufacturer label
- ONSET
- 15min · local effect
- PEAK
- 2h · local peak
- t½
- 10h · if absorbed
- DURATION
- 18h · re-apply
EXCRETION
Renal — absorbed sulfadiazine fraction
route + CYP
INTERACTIONS
2 major
SEVERE in our sources
PREGNANCY
Avoid near term and on large areas (kernicterus risk); limited small-area use otherwise.
FDA category + note
Top interactionssee all 7 →
- Nitrous AcidSevereDatabaseDDInter
- PrilocaineSevereDatabaseDDInter
Mechanism
Releases silver ions that bind microbial DNA and cell membranes (broad bactericidal action) with adjunct sulfonamide effect; used topically to prevent/treat burn-wound infection.
Indications
Prevention and treatment of infection in second/third-degree burnsSelected infected wounds/ulcers
Dosing
- Adult
- Apply 1% cream 1.5–3 mm thick to cleaned burn 1–2 times daily under sterile technique; cover with dressing.
- Pediatric
- As adult topically (avoid neonates <2 months).
- Renal adjustment
- Large-area absorption — caution in renal impairment (sulfonamide/silver accumulation).
- Hepatic adjustment
- Caution with extensive use.
- Geriatric
- No specific topical adjustment.
- Max dose
- Topical to affected burn area 1–2 times daily
Pharmacokinetics
Onset
Local antibacterial effect on application
Peak effect
Local (sustained while in contact)
Duration
Re-apply every 12–24 h
Half-life
Not applicable (topical; sulfadiazine ~10 h if absorbed)
Bioavailability
Low (increased with large burn surface area)
Protein binding
Sulfadiazine moderate (if systemic)
Metabolism
Minimal (topical); hepatic if absorbed
Excretion
Renal (absorbed sulfadiazine fraction)
Contraindications
- Near-term pregnancy, premature infants, neonates <2 months (kernicterus risk)
- Sulfonamide hypersensitivity
- G6PD deficiency (haemolysis — large areas)
Side effects
Common
Local burning/painPruritusRashTransient leukopenia (large-area use)
Serious
- Significant systemic sulfonamide absorption (large burns) — SJS/TEN, blood dyscrasias
- Argyria (prolonged extensive use)
- Haemolysis (G6PD)
- Kernicterus (neonates)
Pregnancy & lactation
Pregnancy
Avoid near term and on large areas (kernicterus risk); limited small-area use otherwise.
Lactation
Avoid in nursing mothers of infants <2 months; caution otherwise.
Drug interactions
Prilocaine
Severe
Database
Clinical effect not specified
Source: DDInter
Topical Proteolytic Enzyme Debriders
Moderate
Database
Silver inactivates enzymes
Do not combine on same wound
Source: Kimi deep-research + Cla
Povidone Iodine
Mild
Database
Reduced antimicrobial efficacy of both agents, potential skin staining.
Avoid concurrent use on the same site. If both are needed, apply sequentially with thorough rinsing in between, or use alternative agents.
Cimetidine
Mild
Database
Additive leukopenia risk
Monitor CBC if large area
Source: Kimi deep-research + Cla
Methotrexate
Mild
Database
Sulfonamide displacement (if absorbed)
Caution with large-area use
Source: Kimi deep-research + Cla
Oral Hypoglycaemics
Mild
Database
Sulfonamide potentiation (if absorbed)
Monitor glucose with extensive use
Source: Kimi deep-research + Cla
5 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about silver sulfadiazine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20