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

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

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)