Is Sulfadiazine Silver compatible with breastfeeding? Do we have alternatives for Sulfadiazine Silver?

Sulfadiazine Silver

May 21, 2017 (Low Risk)

Since the last update we have not found published data on its excretion in breast milk.

10% of sulfadiazine and 1% of silver pass into the systemic circulation by absorption through skin damaged by burns or ulcers (AEMPS 2014). The most common side effect is leucopenia (Fuller 2009). It may cause haemolysis in patients with glucose-6-phosphate dehydrogenase deficiency and kernicterus in the neonatal period (Fuller 2009).

High plasma levels of silver (Moiemen 2011, Lewis 2010), even more than 100 times higher than normal (Wan 1991) have been measured in patients treated for burns or ulcers with a body surface area exceeding 20% with potential clinical toxicity ( Mintz 2008, Browning 2008, Lansdown 2004, Tsipouras 1995, Coombs 1992).

Furthermore, it has been widely used for topical umbilical cord care (Glosan 2013, Ahmadpour 2006) with no reported side effects and its use is permitted after two months of life (Bristol 2012).

During breastfeeding it may be advisable not to use it on skin areas greater than 20% and for short periods.

Do not apply on the chest to prevent the infant from ingesting it; if necessary, apply after breastfeeding and clean well with water before the next feed.

If used during breastfeeding, it is advisable not to apply over a wide area (greater than 20%) or for prolonged periods to avoid systemic absorption. To be avoided in neonatal period and if there is glucose-6-phosphate dehydrogenase deficiency.

List of WHO essential medicines: compatible with breastfeeding (WHO / UNICEF 2002).

Alternatives

We do not have alternatives for Sulfadiazine Silver.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Silver Sulfadiazine

Writings

  • Αργυρούχος Σουλφαδιαζίνη (Greek)
  • Сульфадиазин Серебра (Cyrillic)
  • スルファジアジン銀 (Japanese)
  • C10H9AgN4O2S (Molecular formula)

Drug trade names

References

  1. AEMPS. Sulfadiazina argéntica. Ficha técnica. 2014 Full text (in our servers)
  2. Golshan M, Hossein N. Impact of ethanol, dry care and human milk on the time for umbilical cord separation. J Pak Med Assoc. 2013Abstract
  3. Bristol. Silver Sulfadiazine. Drug Summary. 2012 Full text (in our servers)
  4. Moiemen NS, Shale E, Drysdale KJ, Smith G, Wilson YT, Papini R. Acticoat dressings and major burns: systemic silver absorption. Burns. 2011Abstract
  5. Lewis N, Kolimarala V, Lander A. Conservative management of exomphalos major with silver dressings: are they safe? J Pediatr Surg. 2010Abstract
  6. Fuller FW. The side effects of silver sulfadiazine. J Burn Care Res. 2009Abstract
  7. Browning JC, Levy ML. Argyria attributed to silvadene application in a patient with dystrophic epidermolysis bullosa. Dermatol Online J. 2008Abstract
  8. Mintz EM, George DE, Hsu S. Silver sulfadiazine therapy in widespread bullous disorders: potential for toxicity. Dermatol Online J. 2008Abstract
  9. Ahmadpour-Kacho M, Zahedpasha Y, Hajian K, Javadi G, Talebian H. The effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants. Arch Iran Med. 2006Abstract
  10. Lansdown AB, Williams A. How safe is silver in wound care? J Wound Care. 2004Abstract
  11. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  12. Chin KG, McPherson CE 3rd, Hoffman M, Kuchta A, Mactal-Haaf C. Use of anti-infective agents during lactation: Part 2--Aminoglycosides, macrolides, quinolones, sulfonamides, trimethoprim, tetracyclines, chloramphenicol, clindamycin, and metronidazole. J Hum Lact. 2001Abstract
  13. Tsipouras N, Rix CJ, Brady PH. Solubility of silver sulfadiazine in physiological media and relevance to treatment of thermal burns with silver sulfadiazine cream. Clin Chem. 1995Abstract
  14. Coombs CJ, Wan AT, Masterton JP, Conyers RA, Pedersen J, Chia YT. Do burn patients have a silver lining? Burns. 1992Abstract
  15. Wan AT, Conyers RA, Coombs CJ, Masterton JP. Determination of silver in blood, urine, and tissues of volunteers and burn patients. Clin Chem. 1991Abstract
  16. Boosalis MG, McCall JT, Ahrenholz DH, Solem LD, McClain CJ. Serum and urinary silver levels in thermal injury patients. Surgery. 1987Abstract
  17. Wang XW, Wang NZ, Zhang OZ, Zapata-Sirvent RL, Davies JW. Tissue deposition of silver following topical use of silver sulphadiazine in extensive burns. Burns Incl Therm Inj. 1985Abstract
  18. Lockhart SP, Rushworth A, Azmy AA, Raine PA. Topical silver sulphadiazine: side effects and urinary excretion. Burns Incl Therm Inj. 1983Abstract