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Emerg Med J. Dec 2006; 23(12): 929–932.
PMCID: PMC2564257
Silver sulphadiazine cream in burns
Saiqa Hussain and Craig Ferguson
Report by Saiqa Hussain, Medical Student
Search checked by Craig Ferguson, Clinical Research Fellow
Manchester Royal Infirmary, Manchester, UK
Abstract
A short‐cut review was carried out to establish whether silver sulphadiazine cream is better than normal dressing in promoting healing without infection. A total of 410 papers were found using the reported searches, of which 12 showed the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that although there is evidence of antibacterial effect, there is no direct evidence of improved healing or reduced infection.
Clinical scenario
A 25‐year‐old science teacher presents to the emergency department with a partial thickness burn on her hand because of being careless with a bunsen burner. You wonder if silver sulphadiazine cream is better than normal dressings in reducing the risk of infection and healing time.
Three part question
In [an adult patient with burns] is [silver sulphadiazine cream better than normal dressings] at [reducing infection and decreasing the time required for healing]?
Search strategy
Medline using the OVID interface 1966 to September week 3 2006. [exp Silver Sulfadiazine/OR silver sulphadiazine.mp. OR exp Sulfadiazine/OR flamazine OR flammazine] and [exp Burns/OR thermal injury.mp. OR thermal burn$.mp. OR burn$.mp. OR thermal injur$.mp OR scald.mp. OR heat injur$.mp.] limit to English language and humans.
Cochrane Database of Systematic Reviews Issue 2 2006. “silver sulphadiazine” or “flamazine”
Outcome
410 papers were found in Medline, of which 12 were relevant.
Table thumbnail
Table 1
Comments
Silver sulphadiazine has been shown to decrease the bacterial colonisation of burn wounds. The mechanism is not clear, but each of the components has a synergistic effect on the other to provide a bacteriocidal effect in vivo. Adverse effects include local skin reaction, hypersensitivity reactions and occasionally leucopenia, although this is usually self‐limiting.
Despite this fact, there is little evidence to show that the use of this topical agent reduces bacterial wound infections or sepsis in patients with burns. The small studies listed here suggests that sulphadiazene may in fact delay wound healing and the way forward may be to simply provide a clean, moist and undisturbed environment to allow healing. One confounding factor in these studies may be that the flamazine dressings tended to be changed every 12 h whereas the other dressings were left intact for longer.
Clinical bottom line
Despite evidence of the antibacterial properties of this compound, no evidence showing a definitive improvement in outcome in terms of infection rates or healing time was found. Local advice should be followed.
  • Inman R, Snelling C, Roberts F. et al. Prospective comparison of silver sulfadiazine 1 per cent plus chlorhexidine digluconate 0.2% (Silvazine) and silver sulfadiazine 1% (Flammazine) as prophylaxis against burn wound infection. Burns 1984;11:35-40. [PubMed]
  • Stern H. Silver sulphadiazine and the healing of partial thickness burns: a prospective clinical trial. Br J Plast Surg 1989;42:581-5. [PubMed]
  • Gerding R L, Emerman C L, Effron D., et al. Outpatient management of partial-thickness burns: Biobrane versus 1% silver sulfadiazine. Ann Emerg Med 1990;19:121-4. [PubMed]
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  • Afilalo M, Dankoff J, Guttman A. et al. DuoDERM hydroactive dressing versus silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns. Burns 1992;18:313-16. [PubMed]
  • Soroff H, Sasvary D. . Collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns: a pilot study. J Burn Care Rehabil 1994;15:13-17. [PubMed]
  • Bugmann P, Taylor S, Gyger D. et al. A silicon-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomised trial. Burns 1998;24:609-12. [PubMed]
  • Subrahmanyam M. A prospective randomised clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 1998;24:157-61. [PubMed]
  • Barret L, Dziewulski P, Ramzy P. et al. Biobrane versus 1% silver sulfadiazine in second-degree paediatric burns. Plast Reconstr Surg 2000;105:62-5. [PubMed]
  • Ang E, Lee S, Gan C. et al. The role of alternative therapy in the management of partial thickness burns of the face-experience with the use of moist exposed burn ointment compared with silver sulphadiazine. Ann Acad Med Singapore 2000;29:7-10. [PubMed]
  • de Gracia C. An open study comparing topical silver sulfadiazine and topical silver sulfadiazine-cerium nitrate in the treatment of moderate and severe burns. Burns 2001;27:67-74. [PubMed]
  • Costagliola M, Agrosi M. Second-degree burns: a comparative, multicenter, randomized trial of hyaluronic acid plus silver sulfadiazine vs. silver sulfadiazine alone. Curr Med Res Opin 2005;21:1235-40. [PubMed]
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