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Pharmacological action Silvadene Cream
Silvadene Cream is a chemotherapeutic agent for topical use to prevent and suppress infection in wounds and burns. Burns it reduces the extension of necrosis in depth and provides healing of burnt surfaces.
The mechanism of antimicrobial action of the cream Silvadene Cream different from that of other silver salts and sulfonamides themselves. Silver sulfadiazine in the wound dissotsiruet moderately, and, thus, the silver ions are released slowly and evenly in concentrations that are toxic to microorganisms, but harmless for the cells of the skin and subcutaneous tissue. Silver ions bind with certain components of the bacterial cell, among which the most important is to bind to the RNA of bacteria which leads to the cessation of their growth and reproduction.
Sulfadiazine is found in concentrations well below the IPC, and therefore its direct effect on the bacteria is negligible. This is confirmed by the fact that the P-aminobenzoic acid (PABA) did not inhibit the antimicrobial action of silver sulfadiazine.
The antimicrobial action of Silvadene Cream has silver ions through silver is slowly released from the silver sulfadiazine and therefore only a small portion of silver is inactivated components of body fluids, and the remaining amount is sufficient to destroy microorganisms or inhibit their growth.
Silvadene Cream has a broad spectrum of antibacterial activity that includes almost all types of microbes that cause infections in burn and other wounds on the skin surface: Pseudomonas aeruginosa, Escherichina coli, Proteus spp., Staphylococcus spp., Streptococcus spp., Klebsiella spp., Enterobaster spp., yeasts (Candida albicans) and some strains of herpes virus.
Tests in vitro showed that all strains of Pseudomonas aeruginosa, Proteus mirabilis and Escherichia coli are sensitive to silver sulfadiazine has a concentration of 50mg/ml. For Staphylococcus aureus, Klebsiella spp., Enterobacter, Candida albicans and other fungi MIC of 100 mg / ml. It is established that silver sulfadiazine is 50 times more effective sulfadiazine, mafenid acetate and many other antimicrobial agents.
Pharmacokinetics Silvadene Cream
Silvadene Cream penetrates well into the necrotic tissue and exudate. This effect is particularly important because the systemic effects of antibiotics commonly used in clinical practice, does not reach the microorganisms in the necrotic zone, where the microcirculation is impaired.
Silver sulfadiazine dissociates moderately in the wound, evenly and slowly releasing silver ions. This prevents the rapid and massive binding of silver ions with chloride ions, proteins and other components of body fluids, and there is no electrolyte imbalance.
The number of adsorbed silver is very low and less than 1%. Studies using isotopes of silver have shown that it can not be detected in the organs. Results from animal studies indicate that most of the intake of silver is excreted in bile.
Sulfadiazine may be absorbed up to 10%, while the plasma concentration in the main does not exceed 2.0 mg%. In case of application of the drug on a large number of extensive burn wounds sulfadiazine concentrations in plasma may, in exceptional cases, the approach to the therapeutic values (8-12mg%).
Sulfadiazine is excreted in urine.
Indications Silvadene Cream
Treatment and prevention of burn infections, including up to autodermoplasty
Treatment and prevention of infection of venous ulcers and wounds.
Contra Silvadene Cream
Hypersensitivity to sulfanilamides or any component of the drug.
Application of sulfonamides increases the risk of hyperbilirubinemia, and therefore should not be prescribed Silvadene Cream for women during pregnancy, especially in the later stages of pregnancy and during labor. Its use is contraindicated in premature infants and children during the first 2 months after birth.
Precautions Silvadene Cream
Caution is needed when assigning patients with known hypersensitivity to sulfanilamides of the possible development of cross-reactivity.
As with other local antimicrobials in the treatment of sulfadiazine may develop superinfection.
Requires caution in patients with congenital deficiency of glucose-6-phosphate dehydrogenase from the risk of hemolysis.
Caution is needed when assigning patients with impaired liver and kidney function due to a possible accumulation of the drug because of delayed excretion. Must decide whether to proceed with care, taking into account the possible consequences of its abolition and favor for its continuation. Continuation of treatment carried out under the control of serum concentrations of sulfadiazine.
When applying the cream Silvadene Cream on burn wounds serum concentration of sulfadiazine may reach a level of oral therapy. In this case, requires monitoring of serum concentrations, renal function and urine on the possible presence of sulfadiazine.
With prolonged use Silvadene Cream the cream on a large surface of the skin should be monitored blood formula of the possible development of leukopenia, thrombocytopenia or ezoinofilii.
The drug should not be used in porphyria.
Avoid contact with eyes.
Side effects of Silvadene Cream
Rarely can a local reaction in the form of burning sensation and itching.
There are some reports on the development of skin necrosis, erythema multiforme, skin pigmentation disorders, interstitial nephritis.
Marked by passing individual cases of leukopenia in patients treated with silver sulfadiazine. Leukopenia in the application of silver sulfadiazine is characterized mainly by reduced numbers of neutrophils. The maximum reduction of neutrophils observed at 2-4 days after starting treatment. They were then normalized level for 2-4 days, with continued treatment silver sulfadiazine has no effect on the recovery of white blood cells.
The degree of absorption of silver sulfadiazine, depending on the size and extent of the burn surface tissue damage. In rare cases may develop any adverse reactions characteristic of sulfonamides: hemodyscrasia, including agranulocytosis, aplastic anemia, thrombocytopenia, and hemolytic anemia, allergic skin reactions, including Stevens-Johnson and exfoliative dermatitis, dyspepsia, hepatitis, hepatocellular necrosis, the reaction the central nervous system and toxic nephrosis.
Pregnancy and breast-feeding Silvadene Cream
Silvadene Cream should not be used during pregnancy except in cases where the potential benefit for preserving a woman’s life than the possible harm to the fetus.
Silvadene Cream is contraindicated for women during pregnancy and childbirth (see Contraindications).
Is not known whether silver sulfadiazine passes into breast milk, but other sulfonamides in human milk are found. In addition, all sulfonamides increase the risk of hyperbilirubinemia. Due to the possibility of serious side effects in infants in the application of the nursing mother, sulfonamides, should decide to abolish the drug or to breast-feed while taking into account the degree of significance for the treatment of the mother.
Effects on ability to concentrate
There was no
Drug interactions Silvadene Cream
Sulfadiazine silver may inactivate enzymes for cleansing wounds when they are applied simultaneously. It is noted that the simultaneous use of cimetidine can increase the frequency of leucopenia.
Dosage and Silvadene Cream
Silvadene Cream can be used with or without bandages. The drug is intended only for use on skin. After the surgical treatment of surface burns Silvadene Cream is applied to a layer of 2-4 mm. The cream should be applied 1-2 times a day.
Silvadene Cream treatment should continue until complete healing of the wound surface.
Dosing is the same cream for the treatment of burns and trophic ulcers. Dressings should be changed daily.
Silvadene Cream Overdose
With prolonged use at high body surface concentration of sulphanilamide in serum may approach the level attained at the system application, which can lead to adverse reactions characteristic of sulfonamides. In such cases it is recommended to determine serum concentrations of sulfanilamide.
Treatment is symptomatic, appointed by drinking plenty of fluids (it is recommended to maintain the daily urine output at the level of 1,200-1,500 ml or more)
Argyria due to the increased systemic absorption of silver is not developed.
