How Silvadene Cream Treats Burns and Wounds

Silvadene cream (silver sulfadiazine) is a prescription-only topical medication for treating and preventing severe burn wounds.

Silvadene contains antimicrobial silver ions bonded with an antibacterial sulfa drug. The combination can effectively stop the growth of bacteria that may infect an open burn wound.

Silvadene may be used alone or with other burn or wound treatments in people over 2 months old. Healthcare providers may also prescribe it for other skin infections.

This article explains how Silvadene works and how to use it. It also goes over the potential side effects and effectiveness of Silvadene.

How Silvadene Works

Silvadene is part of a group of medications called sulfa drugs (or sulfonamides)—the oldest type of antibacterial drugs. Silvadene contains sulfadiazine bonded with silver ions, which are also known for antimicrobial effects.

Silvadene kills bacteria by destroying their cell membranes and cell walls. Researchers aren't sure how Silvadene does this—it works differently from other sulfa drugs. 

The cream is approved in the U.S. to treat and prevent sepsis (a life-threatening bodily reaction to infection) in burn wounds. It's typically well-tolerated because the silver ions don't get absorbed by the body; they act only on the surface.

Silvadene can be used on third-degree burns (those that destroy both top layers of skin and may even penetrate the innermost layer) and second-degree burns (those that involve the outer layer and part of the lower layer of skin). It's been widely prescribed for more than 50 years.

How to Use Silvadene

Silvadene is typically applied once or twice daily and reapplied throughout the day when necessary. The National Institutes of Health (NIH) lists the following guidelines for applying Silvadene cream:

1. First, ensure that the area around you and your tools are clean.
2. Clean and debride the burn before applying the cream (remove dead tissue and any foreign material).
3. Plan and stick to an application schedule. Apply once or twice a day with a thickness of about 1/16th of an inch. Wear sterile disposable gloves for application.
4. Cover the wound with gauze or a bandage—especially if you want to safeguard the burn from knocks and bumps. Covering it will also reduce infection risks.
5. Reapply the cream as soon as your daily activities, especially those around water, cause it to wear off.

Keep using the cream until the burn area has healed sufficiently. Make sure to stick to your Silvadene routine for as long as your wound is open enough to be infected.

Reach out to your healthcare provider if your skin's condition hasn't improved or has worsened with the treatment.

Silvadene Side Effects

Silvadene can have side effects. They're usually mild and limited to the areas where the cream is applied. Rarely, you may get serious side effects that can prevent you from using the cream. People can also experience an allergic reaction to Silvadene.

Common Side Effects

Common side effects of Silvadene occur in the areas where it's applied. They include:

• Burning sensation
• Itchy skin
• Pain

If any of these symptoms are severe, contact a healthcare provider right away.

Serious Side Effects

Serious side effects of Silvadene are uncommon. If you experience any of the following, it's important to see a healthcare provider:

• Blood in your urine
• Fatigue
• Fever
• Joint aches and pains
• A new rash on the skin
• Sore throat
• Unexplained bruising or bleeding
• Weakness
• Yellowing of the eyes or skin (jaundice)

Does Silvadene Lower Your White Blood Cell Count?

In a few cases, people have experienced a temporary lower white blood cell count from using Silvadene. In particular, Silvadene can cause a low level of neutrophil cells (neutropenia). Neutropenia was at its worst within two to four days of using Silvadene and went away within two to three days, whether people continued to use Silvadene or not.

You may not feel any symptoms, but neutropenia can increase your chances of getting an infection.

That said, neutropenia doesn't happen in everyone who uses Silvadene—and the cream still has essential benefits such as preventing infection, reducing inflammation, and helping with healing. Don't stop using Silvadene without consulting your healthcare provider first.

Silvadene Safety Precautions

You and your healthcare provider must weigh the risks and benefits of using Silvadene based on your health status and history. You may need to avoid using the cream if:

• You’re allergic to antibiotics in the sulfa family (like Septra, Bactrim, or erythromycin).
• You're sensitive to silver sulfadiazine or any other ingredients in Silvadene.
• You have liver disease, kidney disease, or blood disorders. These conditions can affect how the body breaks down and gets rid of the drug. In some cases, a Silvadene build-up in the body can reach unsafe levels.

Use in Pregnancy and Breastfeeding

Make sure to tell your healthcare provider if you're pregnant. Silvadene is not advised for use if you're close to your due date.

Studies in pregnant rabbits have shown no effects of Silvadene on the fetus—but there haven't been good human studies. Your healthcare provider may still recommend Silvadene if they find it necessary.

Also, tell your healthcare provider if you're breastfeeding—a severe reaction can occur in infants exposed to sulfa drugs. You may need to stop nursing while you are using the medication.

It's not known if Silvadene specifically is excreted in breast milk. However, sulfa drugs have been linked to brain damage in newborns caused by excessive levels of bilirubin (a condition called kernicterus).

How Effective Is Silvadene?

Silvadene's active ingredient, silver sulfadiazine, remains the most commonly used topical (applied to the skin) medication for burn wound infections. However, scientific literature from 2010 and beyond has questioned its effectiveness.

For example, Silvadene is toxic to cells in the epithelium, the body's protective lining, which can slow down minor burn healing.

One 2022 review found that wounds healed faster in people who used Aloe vera plant gel than in those who used silver sulfadiazine cream. Another 2017 review suggested that using honey may improve wound healing compared to silver sulfadiazine.

A 2016 review of silver sulfadiazine cream vs. newer wound dressings showed faster wound healing with the dressings, as well as higher comfort for patients. People may struggle with the application of Silvadene: It needs to be removed and reapplied daily.

How Expensive Is Silvadene?

You can purchase Silvadene at the pharmacy for as low as $18 for 25 grams (0.88 ounces) without insurance. The generic version of Silvadene, silver sulfadiazine, will cost you as low as $12 for 25 grams (0.88 ounces) without insurance. Check with your healthcare provider and insurance plan as to which version is covered and recommended.

The amount you need will depend on the extent of your burns—you'll apply a layer of about 1/16th of an inch over all wounds.

Summary

Silvadene cream, or silver sulfadiazine, can prevent and treat infection in serious burn wounds. It's been prescribed for more than 50 years, but research shows some newer wound dressings can promote faster healing without the need for daily reapplication.

Silvadene's side effects are usually mild and limited to the areas where the drug is applied. In rare cases, you may experience severe or whole-body side effects—these require immediate medical care. People with certain health conditions or people who are pregnant may not be able to use Silvadene.

Your healthcare provider will review the risks and benefits of using Silvadene before prescribing it.