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Silver sulphadiazine

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VOL: 101, ISSUE: 11, PAGE NO: 31

Generic/Proprietary names

Generic/Proprietary names
- Silver sulphadiazine: Flamazine

Action
- Interferes with protein synthesis in bacteria.

Indications
- Prophylaxis and treatment of infection in burn wounds.

- Adjunct to short-term treatment of infection in leg ulcers and pressure ulcers.

- Adjunct to prophylaxis of infection in large abrasions and skin graft donor sites.

- Management of fingertip injuries.

Cautions
- Hepatic and renal impairment.

- Glucose-6-PD deficiency.

- May inactivate enzymatic debriding agents.

Contraindications
- Pregnancy.

- Breastfeeding.

- Sensitivity to sulphonamides.

- Not recommended for neonates.

Side-effects
- Allergic reactions including burning, itching, rashes, urticaria, scaling and redness.

- Argyria has been reported after prolonged use.

- Leucopenia has been reported so blood levels should be monitored if a large area is being treated.

Administration
- Silver sulphadiazine should be applied with a sterile applicator.

- Apply in a layer 3-5mm thick.

- Dressings should be changed daily for burns and three times a week for ulcers.

- In burns, silver sulphadiazine should be applied daily or more frequently if there is heavy exudate.

- It should be applied daily or on alternate days in leg ulcers and pressure ulcers (not recommended if there is heavy exudate).

- It should be applied every two or three days to fingertip injuries.

Nursing considerations
- Assess for allergic reactions - burning, stinging, swelling, redness.

- Assess for signs of nephrotoxicity and ototoxicity.

- Administer enough to cover the lesions completely.

- Before each application, cleanse and dry well.

- Administer to less than 20 per cent of body surface area if the patient has impaired renal function.

- Evaluate the therapeutic response by monitoring the decrease in the size and number of lesions.

- If applying to a large area, remember that plasma sulphadiazine may approach therapeutic levels and the patient may experience side-effects associated with sulphonamide. Because of the association between sulphonamides and severe blood and skin disorders, treatment should be stopped immediately if blood disorders or rashes develop. However, leucopenia that develops two or three days after commencing treatment of a burn is usually self-limiting and silver sulphadiazine need not be discontinued provided blood counts return to normal.

- Store silver sulphadiazine at room temperature in a dry place.

Patient teaching
- The medicine must be stored away from heat and light.

- If the infection or burn does not improve within a few days (or weeks for larger burns), or if it deteriorates, the patient should consult the health care professional.

- In rare circumstances, this medicine can turn the skin a brownish-grey colour.

- Before applying the medicine, the affected area must be cleaned and any dead or burned skin removed.

- Reapply the medicine if it has been rubbed off the affected area by washing or movement.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines.

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