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.

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.