Classifications: sulfonamide;
Therapeutic: topical antiinfective

Prototype: Sulfisoxazole
Pregnancy Category: B


1%/50 g cream


Silver salt is released slowly and exerts bactericidal effect only on bacterial cell membrane and wall, rather than by inhibiting folic acid synthesis; antibacterial activity is not inhibited by p-aminobenzoic acid (PABA).

Therapeutic Effect

Broad antimicrobial activity including many gram-negative and gram-positive bacteria and yeast.


Prevention and treatment of sepsis in second- and third-degree burns.


Hypersensitivity to other sulfonamides; pregnant women at term, premature infants and neonates <1 mo.

Cautious Use

Impaired kidney or liver function; porphyria; impaired respiratory function; G6PD deficiency; thrombocytopenia, leukopenia, hematological disease; pregnancy (category B), lactation.

Route & Dosage

Burn Wound Treatment
Adult/Child: Topical Apply 1% cream 1–2 times/d to thickness of approximately 1.5 mm (1/16 in.)


  • Do not use if cream darkens; it is water soluble and white.
  • Apply with sterile, gloved hands to cleansed, debrided burned areas. Reapply cream to areas where it has been removed by patient activity; cover burn wounds with medication at all times.
  • Bathe patient daily (in whirlpool or shower or in bed) as aid to debridement. Reapply drug.
  • Note: Dressings are not required but may be used if necessary. Drug does not stain clothing.
  • Store at room temperature away from heat.

Adverse Effects (≥1%)

Body as a Whole: Pain (occasionally), burning, itching, rash, reversible leukopenia. Potential for toxicity as for other sulfonamides if applied to extensive areas of the body surface.


Drug: proteolytic enzymes are inactivated by silver in cream.


Absorption: Not absorbed through intact skin, however, approximately 10% could be absorbed when applied to second- or third-degree burns. Distribution: Distributed into most body tissues. Metabolism: In the liver. Elimination: In urine.

Nursing Implications

Assessment & Drug Effects

  • Observe for and report hypersensitivity reaction: Rash, itching, or burning sensation in unburned areas.
  • Lab tests: Obtain serum sulfa concentrations, urinalysis, and kidney function tests when drug is applied to extensive areas. Significant quantities of drug may be absorbed.
  • Observe patient for reactions attributed to sulfonamides.
  • Note: Analgesic may be required. Occasionally, pain is experienced on application; intensity and duration depend on depth of burn.
  • Continue treatment until satisfactory healing or burn site is ready for grafting, unless adverse reactions occur.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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