Due to its antibacterial qualities, Silver Sulfadiazine Cream (Flamazine) is applied to patients with second and third-degree burns in order to treat and prevent infection.

Silver sulfadiazine Cream Uses:

• Burn treatment:

  • When treating and preventing wound infections in patients with second and third-degree burns, it serves as an adjuvant.

Dose in Adults

Silver Sulfadiazine Cream (Flamazine) Dose for burns in adults:

• The burning area must always be protected. It is possible to reapply the cream if it is mistakenly removed or as necessary.
• Until healing has taken place and the burnt region is prepared for skin grafting, the therapy should be continued.
• Once or twice a day, it is topically administered to a thickness of 1/16 inch.
• If there is a chance of infection, the therapy shouldn't be stopped till a negative medication reaction is noticed.

Dose in Children

Note:

• Until healing has taken place and the burnt region is prepared for skin grafting, the therapy should be continued.
• If there is a chance of infection, the therapy shouldn't be stopped till a negative medication reaction is noticed.

Silver Sulfadiazine Cream (Flamazine) Dose for burns in children:

• Infants older than 2 months, Children, and Adolescents:

  • It is applied topically to a thickness of 1/16 inch once or twice daily.
  • The burning area must always be protected. It is possible to reapply the cream if it is mistakenly removed or as necessary.

Pregnancy Risk Category: B

• Animal reproduction studies have not shown adverse pregnancy outcomes. 
• Silver sulfadiazine may cause hyperbilirubinemia or kernicterus in pregnant women, infants under 2 months old, premature infants and infants.

Use during breastfeeding:

• When the medication was administered across a sizable region of skin, significant systemic concentrations had been seen.
• In particular, if the medication has been administered to a tiny region, it is unclear if it will be excreted in breast milk.
• The manufacturer recommends that you stop breastfeeding. This is based on the risk of your infant being exposed to the drug and possible adverse reactions.
• Sulfadiazine should not be used orally, especially by nursing women. It can enter breast milk and give birth to kernicterus in the baby.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution as drug accumulation may occur.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling; Use with caution as drug accumulation may occur.

Side effects of Silver Sulfadiazine cream (Flamazine):

• Hypersensitivity:

  • Hypersensitivity reaction (may be related to sulfa component)
•  

• Dermatologic:

  • Skin photosensitivity
  • Skin rash
  • Erythema multiforme
  • Pruritus
  • Skin discoloration

• Hepatic:

  • Hepatitis

• Hematologic & oncologic:

  • Hemolytic anemia
  • Agranulocytosis
  • Aplastic anemia
  • Leukopenia

• Renal:

  • Interstitial nephritis

Contraindications to Silver Sulfadiazine cream (Flamazine):

• Premature infants and neonates are those who are less than 2 months old
• Patients who are allergic to sulfa drugs.
• Silver sulfadiazine and any other formulation component allergies
• Women who are expecting or who intend to get pregnant soon
• Cross-sensitivity can occur in patients allergic to sulfa drugs.

Warnings and precautions

• Allergy to sulfonamide

  • Chemically, sulfuramides, loop diuretics, carbonic anhydrase inhibitors, thiazides and sulfonylureas are all chemically identical, except ethacrynic acids.
  • Patients who are allergic to sulfa medications shouldn't take it. Patients who are allergic to other sulfa medications shouldn't use it.

• Superinfection

  • Long-term use can lead to serious fungal and bacterial superinfections. It is possible for fungal proliferation to occur below and within the eschar.
  • CDAD (C. difficile -associated diarrhea) or pseudomonas colitis can rarely be caused by prolonged use of the drug. CDAD can occur even after the last two-month-old dose of antibiotics.

• Systemic effects

  • Systemic effects may be caused by significant systemic absorption.

• G6PD deficiency:

  • Patients with G6PD deficiency may experience hemolysis. These patients should not use it.

• Hepatic impairment

  • Patients with impaired liver function may be at risk of accumulating sulfadiazine. Patients with liver impairment should use it with caution.

• Renal impairment

  • Patients with impaired renal function may be at risk of accumulating sulfadiazine. These patients should be cautious when using sulfadiazine.

Silver sulfadiazine: Drug Interaction

Monitoring parameters:

• Serum electrolytes
• Urinalysis
• Renal function tests
• CBC in patients receiving long-term care for severe burns.
• Serum sulfa levels, if clinically necessary.

How to administer Silver Sulfadiazine cream (Flamazine)?

• It is indicated for topical use only. Contact with mucosal surfaces and eyes should be avoided.
• Applying it needs to be done with sanitary gloves on. It is important to cover all the burned areas with the medicine all the time.
• If the cream has been removed, it should be reapplied. Patients may use dressings over the area. The cream should be reapplied after hydrotherapy.

Mechanism of action of Silver Sulfadiazine (Flamazine):

Numerous species can be killed by it by having an impact on their cell membranes. Yeast, gram-positive, and gram-negative cells are all susceptible to its effects. The following organisms are resistant to it.

• Enterobacter species
• Escherichia coli
• Proteus mirabilis
• Corynebacterium diphtheriae
• Clostridium perfringens
• Morganella morganii
• Providencia rettgeri
• Pseudomonas aeruginosa
• Pseudomonas maltophilia
• Klebsiella species
• Staphylococcus aureus
• Staphylococcus epidermidis
• Proteus vulgaris
• Providencia species
• Citrobacter species
• Enterococcus species
• Candida albicans
• Serratia species
• Acinetobacter calcoaceticus

Absorption:

• When applied to both normal skin and severe and superficial burns, negligible)
• Blister removal increases absorption.

Half-life elimination:

• Sulfadiazine: About 24 hours.

Excretion:

• Silver: sluggish excretion rate in the faeces; sulfadiazine: 6.6% of urine in 5 days.

International Brand Names of Silver sulfadiazine:

• Silvadene
• SSD
• Dermazin
• Flamazine
• Aldo-Silvederma
• Argentafil
• Argentamicina
• Argenzil
• Bactin
• Bactrazine
• Burnazin
• Burnsil
• Burnzorb
• Canflame
• Dermazin
• Diasilve
• Falmmazine
• Flamazine
• Flammazine
• Flugen
• No-Burn
• Platsul-A
• Silbecor
• Silmazin
• Silvadene
• Silvadex
• Silvadiazin
• Silvadiazine
• Silvadin
• Silvederma
• Silverderm
• Silverdiazina
• Silverin
• Silvex
• Silvirin
• Silzine
• Sofargen
• Sterizol
• Sulfadiacina de Plata
• Sulfaplata
• Sulfargin
• Sulfasil
• Synvodex

Silver sulfadiazine Brand Names in Pakistan: