The Side Effects of Silver Sulfadiazine

Silver sulfadiazine cream has an enviable safety record in burn treatment. However, it side effects, exemplified by allergic reactions to its sulfadiazine moiety, silver staining of the treated burn wound, hyperosmolality, methemoglobinemia, and hemolysis due to a congential lack of glucose-6-phospate dehydrogenase, may be missed or misinterpreted. Early post burn leukopenia, once thought to be a side effect of the use of silver sulfadiazine in burn wound therapy, is no longer regarded as such since it has been found to occur with the use of other burn topical agents. Its presence is no longer an indication to discontinue silver sulfadiazine burn wound therapy. Because these side effects are uncommon, any one physician or burn facility usually has limited experience in diagnosing and treating them. (J Burn Care Res 2009;30:464-470)