Silcream

Approved Medical Uses:

• Burn Wounds: Prevention and treatment of infection in second- and third-degree burns.
• Skin Ulcers: Adjunctive therapy in pressure sores, venous stasis ulcers, and diabetic foot ulcers.
• Skin Graft Sites: Management of donor and recipient sites to prevent infection.
• Traumatic Wounds: Including abrasions and surgical incisions at high risk of bacterial contamination.

Important Off-label Uses:

• Partial-thickness burns in outpatient care.
• Wound infection prophylaxis in compromised skin from dermatological procedures (under clinical supervision).

Adults and Elderly:

• Apply a 1.6 mm (1/16 inch) thick layer of 1% cream to the affected area once or twice daily.
• The wound should be cleaned before application.
• Reapply as needed to maintain continuous coverage.
• May be used with or without dressings depending on wound type.

Pediatrics (>2 months):

• Apply similarly to adults.
• Not recommended for neonates or premature infants due to the risk of kernicterus.

Renal/Hepatic Impairment:

• Use cautiously due to the potential for increased systemic absorption, especially when applied to large surface areas or broken skin.
• Monitor renal and hepatic function during prolonged therapy.

Administration Route:

• Topical only. Not for oral, ophthalmic, or intravaginal use.

Silver Sulfadiazine acts through two main components:

• Silver ions bind to microbial DNA, proteins, and cell walls, disrupting bacterial replication and cell integrity.
• Sulfadiazine, a sulfonamide antibiotic, inhibits bacterial dihydropteroate synthase, blocking folic acid synthesis.

This combination provides broad-spectrum antibacterial activity, particularly effective against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and Proteus species.

• Absorption: Minimal through intact skin; increased absorption through large burns or broken skin.
• Distribution: Systemically absorbed sulfadiazine distributes to most tissues and crosses the placenta.
• Metabolism: Hepatically acetylated.
• Elimination: Primarily via kidneys (urine), both as parent drug and metabolites.
• Half-life (sulfadiazine): ~7–17 hours.
• Onset of Action: Begins within hours after topical application.

• Pregnancy: Category C
• Risk of kernicterus if used near term.
• Avoid use in late pregnancy.
• Lactation:
• Excreted in breast milk.
• Use with caution, especially in breastfeeding neonates or preterm infants.

• Primary: Topical Antimicrobial Agent
• Pharmacologic Class: Sulfonamide derivative combined with silver compound

• Hypersensitivity to silver compounds or sulfonamides
• Infants under 2 months old
• Pregnant women near term
• Severe renal or hepatic impairment
• G6PD deficiency (increased risk of hemolysis)

• Systemic Absorption Risk: Especially in large burns; may cause sulfonamide-related effects (e.g., nephrotoxicity, hematologic changes).
• Transient leukopenia may occur during treatment.
• Prolonged use may delay wound healing in some cases.
• Do not apply near the eyes, mucosa, or deep puncture wounds.
• Monitor complete blood count (CBC), renal, and hepatic function with extended use or extensive coverage.

Common:

• Local burning or pain
• Rash
• Skin discoloration (gray or blue tint, temporary)

Less Common:

• Pruritus
• Erythema
• Dry skin

Serious (Rare):

• Leukopenia
• Stevens-Johnson syndrome
• Crystalluria
• Nephrotoxicity
• Hypersensitivity reactions
• Methemoglobinemia
• Hepatitis

• Topical proteolytic enzymes (e.g., trypsin, collagenase): Activity reduced by silver.
• Cimetidine: May increase risk of leukopenia when used concurrently.
• Other sulfonamides or nephrotoxic drugs: May increase systemic toxicity.

• Burn management guidelines now reserve Silver Sulfadiazine for infected or high-risk burns.
• Evidence suggests hydrogel dressings may promote faster healing in superficial burns.
• Updated caution on use in neonates and near-term pregnancy due to improved pharmacovigilance data.
• Still widely used in developing countries and resource-limited settings due to broad-spectrum activity and cost-effectiveness.

• Temperature: Store at below 25°C.
• Protect from light and moisture.
• Keep container tightly closed.
• Do not freeze.
• Shelf-life: Follow expiry on packaging; once opened, discard if contamination is suspected or after 7–10 days of use on open wounds.