Use Of Silver Sulfadiazine Research Articles

515 Retrospective Review of Silver Sulfadiazine use in Sulfa Allergic Patients at a Regional Burn Center

Abstract Introduction Plastic Surgeons are commonly called upon to evaluate wounds. Most wounds in otherwise healthy individuals will heal with minimal intervention, however in patients with comorbid conditions and systemic disease the incidence of nonhealing wounds is much more prevalent. Silver sulfadiazine is the most common topical antimicrobial used in burn management. Current literature recommends avoiding the use of silver sulfadiazine in burn patients with sulfa allergies. The intent of this retrospective review is to examine the safety of silver sulfadiazine use in documented sulfa allergic burn patients at a level one trauma hospital and regional burn center. Methods After obtaining IRB approval for electronic chart review of patients who were treated with silver sulfadiazine, charts were reviewed and exclusion criteria applied. Patients included in the study had documented burns treated by burn team providers, application of topical silver sulfadiazine for primary burn management, and a documented sulfa allergy. Chart review identified 70 patients who met the stated criteria out of 2,644 patients treated over a five year period. Results None of the 70 patients with documented sulfa allergies suffered adverse reactions to silver sulfadiazine use for primary burn care. There were no documented systemic or anaphylactic reactions, hives, or additional adverse reactions after administration. No cessation of the medication was documented due to intolerance. Conclusions Silver sulfadiazine is a common topical antimicrobial treatment in acute burn care. It has previously been avoided in patients with documented sulfa allergy due to concern for cross reactivity. However, in this population of patients, there were no documented adverse reactions to topical silver sulfadiazine. This study suggests that withholding topical sulfonamides from patients with prior reactions to antibacterial sulfonamides may not be clinically justified. Applicability of Research to Practice We present evidence in our retrospective review that administration of topical silver sulfadiazine for primary burn care can be done in a safe manner, without adverse allergic reactions.

A textile device for the therapy of patients with burn wounds by the use of a drug delivery from a hydrogel to dermis

The paper proposes a textile device for patients with large area burn wounds consisting of an assembly made up of a knitted backing layer, a hydrogel, with an antibiotic content, as a second layer and a membrane with controlled porosity located directly at the interface with the wound. The knit is the material support with a supporting clothing role, but also as a solution tank. The hydrogel has a keratin structure obtained from human hair with advanced swelling capacity and porosity. The study proposes the use of silver sulfadiazine (SSD), an antibiotic used in the topical therapy of burn wounds. The work optimizes the degree of swelling, evaluates the porosity of the hydrogel and designs the support garment for wound therapy. The optimal parameters to obtain the maximal swelling degree are: duration of hydrolytic reaction 180 min, volume of hydrogen peroxide 3.7 mL and duration of oxidation 90–125 min. Based on these optimal parameters one can obtain swelling degrees higher than 1000%. The device proposed is reusable and supports the SSD diffusion to wound.

Comparison of clinical practice guidelines on radiation dermatitis: a narrative review.

Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.

The Outpatient Prescribing of Silver Sulfadiazine in Al-Kharj

Aim: The aim of the present study was to describe the outpatient prescription of silver sulfadiazine in Al-Kharj.
 Methodology: This study was conducted in a public hospital in Alkharj. The data were collected from the outpatient pharmacy in the hospital and includes outpatients who received silver sulfadiazine in 2018.
 Results: All of the silver sulfadiazine prescriptions were prescribed for 7 days. The prescriptions were made mainly by residents (96.67%). Most of the prescriptions were prescribed by emergency department (90.00%).
 Conclusion: The use of silver sulfadiazine was uncommon in Alkharj possibly due to the use of effective natural medicines. Silver sulfadiazine could lead to several adverse effects so it is important to increase the awareness about the wise use of silver sulfadiazine and other topical antibiotics.

A small-scale re-evaluation of the efficacy of silver sulfadiazine for burns.

Burns remain one of the most common injuries contributing to an increase in trauma incidence in hospitals, particularly in developing countries. Therefore, it is essential to identify the appropriate care for these wounds. Silver sulfadiazine has been widely used for the treatment of burns, but its efficacy has not been re-evaluated in recent years. Therefore, this small-scale study aimed at re-evaluating the use of silver sulfadiazine in patients with burns at a hospital in Magelang, Indonesia. A total of seven patients with second- and third-degree burns were involved and received silver sulfadiazine for 5 months (March to July 2020). Data on their wounds were collected three times and evaluated by using the Nursing Outcomes Classification (NOC) observation method. Wound outcomes were evaluated using on the basis of wound healing by secondary intention. Silver sulfadiazine was found to be effective; 85.7% of the wound area showed granulation tissue, and 75-100% of the wound area showed epithelialisation. However, patients complained of pain during silver sulfadiazine treatment. Therefore, additional nursing interventions seem to be needed to manage burns.

Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers.

Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing Staphylococcus aureus and Pseudomonas aeruginosa. All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing S. aureus and P. aeruginosa isolates was assessed in vitro. A total of 16 patients with S. aureus and P. aeruginosa infected DFUs were included in the study. Clinical data showed a statistically significant (p < 0.002) improvement of patients’ DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both S. aureus and P. aeruginosa isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly (p ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both S. aureus and P. aeruginosa at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing S. aureus and P. aeruginosa.

Eastern Association for the Surgery of Trauma: A Review of the Management of the Open Abdomen—Part 2 “Management of the Open Abdomen”

During the course of the last 30 years, several authors have contributed their clinical experience to the literature in an effort to describe the various management strategies for the appropriate use of the open abdomen technique. There remains a great degree of heterogeneity in the patient population, and the surgical techniques described. The open abdomen technique has been used in both military and civilian trauma and vascular and general surgery emergencies. Given the lack of consistent practice, the Eastern Association for the Surgery of Trauma (EAST) Practice Management Guidelines Committee convened a study group to establish recommendations for the use of open abdomen techniques in both trauma and nontrauma surgery. This has been a major undertaking and has been divided into two parts. The EAST practice management guidelines for the open abdomen part 1 “Damage Control” have been published.1 During the development of the open abdomen part II “Management of the Open Abdomen,” the current literature remains contentious at best, current methods of treatment continue to change rapidly, and patient populations are so heterogeneous that clear recommendations could not be provided. What follows is a thorough review of the current literature for the management of the open abdomen: part 2 “Management of the Open Abdomen” and provides clinical direction regarding the following specific topics.

Acticoat dressings and major burns: Systemic silver absorption

Despite widespread use of wound dressings containing silver, few studies have investigated patients’ serum silver levels. An earlier study of Acticoat use in small burns showed transient elevations of serum silver. The aim of this study was to examine the serum silver profile when Acticoat is used in major burns. A prospective study of 6 patients with burns greater than 20% total body surface area (TBSA). All burn wounds, including grafted and non-grafted areas and skin graft donor sites, were dressed with Acticoat or Acticoat Absorbent. Patients’ serum silver levels, biochemistry and haematology were examined before, during and after the application of the silver dressings. The median total wound size (including donor sites) was 46.1% TBSA. The median maximum serum silver level recorded, 200.3 μg/L, reached at a median of 9.5 days following initial silver dressing application. This decreased to a median of 164.8 μg/L at the end of the treatment period and to a median of 8.2 μg/L at the end of follow-up. One adverse event, partial skin graft loss was thought to be dressing related. In this small study, serum silver levels were elevated but remained similar to that reported following the use of silver sulfadiazine. This study confirmed our view that Acticoat is safe to use on patients with burns, even when they are extensive.

The Side Effects of Silver Sulfadiazine

Silver sulfadiazine cream has an enviable safety record in burn treatment. However, it side effects, exemplified by allergic reactions to its sulfadiazine moiety, silver staining of the treated burn wound, hyperosmolality, methemoglobinemia, and hemolysis due to a congential lack of glucose-6-phospate dehydrogenase, may be missed or misinterpreted. Early post burn leukopenia, once thought to be a side effect of the use of silver sulfadiazine in burn wound therapy, is no longer regarded as such since it has been found to occur with the use of other burn topical agents. Its presence is no longer an indication to discontinue silver sulfadiazine burn wound therapy. Because these side effects are uncommon, any one physician or burn facility usually has limited experience in diagnosing and treating them.

Initial nonoperative management and delayed closure for treatment of giant omphaloceles

Purpose Traditional treatment of giant omphaloceles with silo closure has been associated with respiratory insufficiency, hemodynamic compromise, dehiscence, and inability to close the abdomen with subsequent death. To minimize such complications, initial nonoperative management with delayed closure of the defect has been used. Methods Between January 1981 and December 2002, 111 patients with omphaloceles were treated. Twenty-two patients with giant omphaloceles (19 containing liver) underwent initial nonoperative management consisting of silver sulfadiazine dressing changes. After pulmonary and other comorbidities stabilized, the contents were gradually reduced with a loose elastic bandage, and delayed closure was planned at 6 to 12 months. The medical records of these 22 patients were retrospectively reviewed to determine the efficacy and safety of this technique in the setting of severe associated anomalies. Those 15 patients (n = 15) from the latter 10 years were further reviewed to determine additional end points (length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation, time to feed, time to closure, and type of closure). Results Of the 15 patients treated during the latter 10 years, mean gestational age and birth weight were 38 ± 1.4 weeks and 3.1 ± 0.57 kg, respectively. Median length of stay after birth was 20 days (range, 5-239 days). Median time to full diet was 8 days (range, 4-80 days). Four patients were discharged on oral feedings only, 7 with combination oral/gavage, and 4 with tube feedings. Pulmonary hypoplasia or pulmonary hypertension was present in 11 (50%) of 22 patients. There were 11 patients with major cardiac anomalies, 14 with a patent ductus arteriosus, and 8 with a patent foramen ovale. Three early complications (2 ruptured sacs and 1 bleeding sac) and 1 late complication (gastric necrosis) occurred in the initial nonoperative period. In addition, 4 patients were treated for line sepsis, 1 patient for acute renal insufficiency, and 1 for aspiration pneumonia. Three patients required tracheostomy and were discharged with home ventilators. There were no complications associated with the use of silver sulfadiazine. Of the 22 patients, 16 have undergone delayed repair, 2 did not require repair, 1 is awaiting repair, 2 died before closure, and 1 was lost to follow-up. Delayed closure was achieved at a median age of 14 months (range, 2-28 months) and mean weight of 8.8 ± 3.3 kg. Four patients required implantation of mesh for definitive closure. Median postoperative length of stay was 4 days (range, 2-21 days). Postoperative complications included prolonged ileus, recurrent ventral hernia, and prolonged intubation. Overall mortality rate was 9.1%. One death occurred after diaphragmatic hernia repair, and 1 death was from overwhelming sepsis in the patient with a late gastric perforation. Conclusion The use of silver sulfadiazine dressing changes for initial nonoperative management of giant omphaloceles is a safe and effective bridge to delayed closure. We recommend this method as initial nonoperative management given the high incidence of associated cardiopulmonary malformations because it may facilitate enteral feeding, minimize respiratory compromise, and reduce morbidity and mortality.

New method of surgical delayed closure of giant omphaloceles: Lazaro da Silva’s technique

Background/Purpose The management of patients with a giant omphalocele remains a difficult problem. In this study, the authors described a new surgical approach for delayed closure of ventral hernia—the Lazaro da Silva’s technique—in conservatively treated patients. Methods Ventral hernias of 11 conservatively treated patients were corrected by Lazaro da Silva’s technique from 1987 to 2002 in Clinic’s Hospital of UFMG. The surgical procedure consisted of the bilateral longitudinal fibroperitoneal-aponeurotic transposition, resulting in 3 different layers of closure. The evolution of these patients is reported. Results The presence of associated anomalies was observed in 8 patients (73%), with a predominance of cardiac defects. No alterations were associated with the use of silver sulfadiazine for epithelialization. Despite the size of the ventral hernia, no difficulties were related to the surgical procedure. Furthermore, no peri- and postoperative complications were observed. The hospital stay was approximately 8 days. The aesthetic result was excellent in all patients, and no recurrence of ventral hernia was observed. Conclusions These results lead to the conclusion that conservative management of giant omphaloceles with delayed closure of the ventral hernia using Lazaro da Silva’s technique is a safe and reliable approach for treating these critically ill patients.

Agranulocytose après application de sulfadiazine argentique chez un nourrisson de 2 mois

Background. — Agranulocytosis associated with the use of silver sulfadiazine has been described in burn patients. This agranulocytosis may be due to either an allergic reaction or a bone marrow toxicity by silver sulfadiazine. Case report. — A 1-month old baby was hospitalized in pediatric intensive care unit after a stage one repair of a tracheosophegeal fistula. Gastroesophageal reflux and tracheomalacia appeared in the post operative period. When she was 2-months old, she developed a perineal erythema. A topical therapy was begun, with daily applications of silver sulfadiazine and ketoconazole. Five days later, agranulocytosis (granulocytes = 0.21 × 10 9 L −1) occurred. Silver sulfadiazine therapy was immediately stopped. Granulocyte count returned to normal over a few days. No other etiology than silver sulfadiazine could be found to explain agranulocytosis. The small surface of administration, the chronology of the events and the rapid correction of the disorders after silver sulfadiazine interruption argued for an immuno-allergic reaction to this drug. Medical problems were easily controlled and the patient recovered well. Conclusion. — This event occurred when sulfadiazine was applied in a small cutaneous area in a young baby. This may be an argument for an allergic reaction; alternatively, it could be explained by an increased cutaneous absorption of a cytotoxic drug in younger people.

Regional and institutional variation in burn care.

In reviewing the literature on burn therapy and observing clinical burn care, we noted differences among institutions and individual experts in several areas. To study variation in burn care, we surveyed the 140 burn centers listed by the American Burn Association to determine how burn care is currently administered in the United States and Canada. Responses were obtained from 83 hospitals (60%). The survey addressed resuscitation, operative and nonoperative wound care, medications, antimicrobial agents, and pain control. The major influence on care appeared to be the experience of the director (considered "very influential" in 85%) compared with the literature ("very influential" in 12%) and habit/what works for us ("very influential" in 48%). The Parkland formula was used "always" or "often" by 78%, and the Brooke formula "never" by 81% of respondents. Lactated Ringer's solution was the most popular initial fluid, and most (78%) respondents changed fluids after 24 hours. However, the fluids used in the second 24 hours varied equally among several choices. The use of colloids also varied without a set pattern. Furosemide (Lasix) and nonsteroidal antiinflammatory drugs were used "rarely" or "never" by 67% of centers in the acute stage. H2 blockers were used for gastritis prophylaxis "always" or "often" in 60% (vs 53% for antacids and 20% for sucralfate [Carafate]). Tube feedings were started on day 1 after burn injury "always" by less than 30% of centers. Total parenteral nutrition was not commonly used. Most centers use of silver sulfadiazine on the body and hands, but facial topical antimicrobial therapy varied.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential inhibition of human basal keratinocyte growth to silver sulfadiazine and mafenide acetate

The impact of topical antimicrobial agents on improving the survival of patients with major thermal injuries is significant. However, the effects of these agents on cells responsible for wound healing has only recently received attention. Fresh human basal keratinocytes were grown in serum-free modified MCDB 153 medium under standard tissue culture conditions. Cells were subsequently exposed to concentrations of silver sulfadiazine and mafenide acetate as low as 1 100 of that used clinically over a period of 5–7 days. Cellular responses documented with hemocytometer cells counts, cellular protein assays, phase-contrast microscopy, and transmission electron microscopy show only severe toxicity to mafenide acetate. Such data imply that inhibition of wound epithelialization is greater with the use of mafenide acetate than with the use of silver sulfadiazine.

Silver sulfadiazine and hydrocortisone cream 1% in the management of phenol matricectomy

The phenol matricectomy is one of the most common procedures performed in the podiatrist's office. Since a chemical burn is produced, correct care of the wound is essential. The authors studied the use of silver sulfadiazine, hydrocortisone cream, and a mixture of the two, on wounds resulting from phenol matricectomy procedures. The study shows that when silver sulfadiazine and hydrocortisone are used in combination, some of the usual sequelae seen with phenol matricectomies are markedly reduced and wound healing progresses at a more rapid rate with less complications.

Combined topical use of silver sulfadiazine and antibiotics as a possible solution to bacterial resistance in burn wounds.

The superior efficacy of quinolones (norfloxacin, pefloxacin, and enoxacin) in controlling burn wound infections signals the discovery of new topical agents. However, there are a few reports on the emergence of resistant mutants to quinolones. Since attempts to develop AgSD resistant strains in vitro were unsuccessful and the emergence of AgSD resistance in vivo is a rare occurrence, we decided to investigate if the combined use of AgSD with other effective antibiotics, especially quinolones, would minimize the development of resistant bacteria. Our in vitro results indicate that when Ps. aeruginosa cultures were serially transferred 10 times through subinhibitory concentrations of norfloxacin, pefloxacin, etc., the MIC increased 40 times while when the cultures were passed through a combination of AgSD and these quinolones, the MIC of quinolones increased only tenfold. In vivo, when burned mice infected with either AgSD sensitive or resistant Ps. aeruginosa strains were treated with a topical cream containing 10mM silver sulfadiazine and 5mM norfloxacin or 5mM pefloxacin, the mortality was much lower than that of 10mM silver sulfadiazine alone or 5mM quinolones alone. Thus, combined use of silver sulfadiazine and quinolones appears to diminish the ability of Ps. aeruginosa strains to form resistant mutants. Furthermore, when the combination is used as a topical agent in burn wounds, lesser amounts of the individual drug are needed to control infection thereby reducing the toxic effects, if any, associated with these drugs. This combination does not in any way interfere with the antifungal or antibacterial properties of these individual drugs.

Tissue Deposition of Silver Following Topical Use of Silver Sulfadiazine in Extensive Burns

Tissue Deposition of Silver Following Topical Use of Silver Sulfadiazine in Extensive Burns

Prospective study of side effects associated with the use of silver sulfadiazine in severely burned patients.

We report the results of a prospective study of 45 burn patients in whom serum and urine levels of cream constituents (sulfadiazine and propylene glycol) were determined and correlated with clinical parameters and the presence of an immune response to sulfadiazine. Propylene glycol, measured by gas chromatography, was found in the serum of 53% of study patients. Sulfa, determined by spectroscopy, was found in the serum of all patients, with values as high as 9.1 mg/dl within 24 hours of topical application. Ninety percent of tested patients had circulating sulfadiazine antibodies, predominantly IgG. Fourteen patients died, 11 of whom had interpretable renal biopsies. Five of these biopsies showed positive immunofluorescent linear or granular staining for IgG, IgM, IgA, or C'3; none of these 5 patients had clinical evidence for the nephrotic syndrome. The association between antisulfadiazine antibodies, circulating immune complexes, immunoglobulin disposition on glomerular basement membranes, and topical application of silver sulfadiazine provides evidence for sulfadiazine sensitization in patients with severe burns.

Granulocytes, Lymphocytes, and Toxic Epidermal Necrolysis

To the Editor.— The overall mortality rate of 70% in Westly and Wechsler's 1 ten patients was relatively high and contrasts with the 30% figure cited by Fritsch and Elias 2 and the 20% to 50% range cited by Lyell, 3 making either their patient population or their manner of treatment different from that of other groups. One possibility in this regard is their use of silver sulfadiazine (Silvadene) to treat some patients. An important factor is the capacity of silver sulfadiazine to attain therapeutic plasma concentrations when used to treat large, denuded skin surface areas, as frequently occurs in TEN. 4 Moreover, both granulocytopenia and pancytopenia may accompany some toxic effects of sulfonamides by inducing bone marrow maturation arrest at the myoblast stage. 4 Of particular relevance is the conclusion drawn by the authors that steroids are unwarranted in the treatment of TEN. Since three patients had suspected sulfonamide-related

The use of silver sulfadiazine in the treatment of burns—a review of 179 cases

The use of silver sulfadiazine in the treatment of burns—a review of 179 cases