Silver Sulfadiazine

This post is thanks to my brother, calling me to ask about his thumb.  He got a second degree burn from spilling BBQ sauce on it at a restaurant.  It blistered, the blister popped while he was golfing and the area was now shiny red and painful.  He had some Silver Sulfadiazine (from the doctor for a previous burn) and triple antibiotic cream.  He wanted to know how to best manage his injury.  

If anyone has good ND approach to care, please comment...

Management of 2nd degree burn (5 min Clinical): 

• Prognosis: 2nd-degree burn: Epithelialization in 10–14 days (deep 2nd-degree burns probably will require skin graft)
• Soak the burn in cool water for 15 minutes. If the burned area is small, put cool, clean wet cloths on the burn for a few minutes every day. Then put on an antibiotic cream or other creams or ointments prescribed by your doctor. Cover the burn with a nonstick dressing (for example, Telfa) and hold it in place with gauze or tape.
  Check the burn every day for signs of infection, such as increased pain, redness, swelling or pus. If you see any of these signs, go to your doctor right away. To prevent infection, avoid breaking blisters.
  Change the dressing every day. First, wash your hands with soap and water. Then gently wash the burn and put antibiotic ointment on it. If the burn area is small, a dressing may not be needed during the day. Make sure you are up-to-date on tetanus shots. If you aren't sure, check with your doctor's office.
  Burned skin itches as it heals. Keep your fingernails cut short and don't scratch the burned skin. The burned area will be sensitive to sunlight for up to one year.
  Link: http://www.aafp.org/afp/2000/1101/p2029.html

Today's med: Silver Sulfadiazine (brand names: Silvadene, SSD, Thermazene)

Drug Class: Antibiotic, topical

Other Drugs in this class: Ampicillin,Rifampin, Norfloxacin, Dapsone,Sulfacetamide, Tigecycline, 

Cefoperazone,Hydrocortisone/Acetic acid, Gemifloxacin,Sulfisoxazole, Sulfacetamide/sulfur,Sulfacetamide Sodium,Sulfacetamide/Prednisolone

Indications: Prevention and treatment of infection in second and third degree burns

Contraindications: Hypersensitivity to silver sulfadiazine or any component of the formulation; premature infants or neonates <2 months of age (sulfonamides may displace bilirubin and cause kernicterus); pregnancy (approaching or at term)

Actions: Acts upon the bacterial cell wall and cell membrane. Bactericidal for many gram-negative and gram-positive bacteria and is effective against yeast. Active against Pseudomonas aeruginosa, Pseudomonas maltophilia, Enterobacter species,Klebsiella species, Serratia species, Escherichia coli, Proteus mirabilis, Morganella morganii, Providencia rettgeri,Proteus vulgaris, Providencia species, Citrobacter species, Acinetobacter calcoaceticus, Staphylococcus aureus,Staphylococcus epidermidis, Enterococcus species, Candida albicans, Corynebacterium diphtheriae, and Clostridium perfringens

Adverse Effects: Dermatologic: Discoloration of skin, erythema multiforme, itching, photosensitivity, rash; Hematologic: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia; Hepatic: Hepatitis; Renal: Interstitial nephritis; Miscellaneous: Allergic reactions may be related to sulfa component

Standard Dosing: Children and Adults: Topical: Apply once or twice daily with a sterile-gloved hand; apply to a thickness of ¹/₁₆”; burned area should be covered with cream at all times

Administration

Apply with a sterile-gloved hand. Apply to a thickness ¹/₁₆”. Burned area should be covered with cream at all times.

Storage

Discard if cream is darkened (reacts with heavy metals resulting in release of silver).

Drug interactions: Link: http://www.drugs.com/drug-interactions/silver-sulfadiazine-topical.html

A total of 9 drugs (37 brand and generic names) are known to interact with silver sulfadiazine topical.

• 6 major drug interactions (13 brand and generic names)
• 3 moderate drug interactions (24 brand and generic names)

Show all medications in the database that may interact with silver sulfadiazine topical.

BCG: Antibiotics may diminish the therapeutic effect of BCG. Avoid combination

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification

Lidocaine/prilocaine topical: together with silver sulfADIAZINE topical. Prilocaine topical can cause a condition called methemoglobinemia that reduces the oxygen-carrying capacity of the blood to different organs, and combining the medication with silver sulfADIAZINE topical may increase the risk. Infants and patients with certain conditions such as glucose-6-phosphate dehydrogenase deficiency or anemia are more likely to develop this condition.