Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers.
BACKGROUND
For decades silver-containing antibiotics such as silver sulfadiazine (SSD) have been applied as standard topical therapy for patients with partial-thickness burns and venous stasis ulcers. This evidence-based review intends to answer the following research question: in ambulatory patients with partial-thickness burns or stasis dermatitis ulcers, does the use of topical SSD compared with nonantibiotic dressings improve mortality, wound healing, re-epithelialization, or infection rates?


METHODS
MEDLINE, EMBASE, Cochrane Library, and other databases were searched. We considered trials that enrolled patients of any age with partial-thickness burns or venous stasis ulcers and randomized them to either topical SSD or placebo, saline-soaked gauze, paraffin gauze, sterile dry dressing, or nonantibiotic moist dressing. Outcomes included mortality, wound healing, speed of re-epithelialization, and infection rates.


RESULTS
For burns, our search revealed 400 potential articles. No human studies met the inclusion criteria. Only 7 animal studies (1 mouse, 4 rat, and 2 pig) were relevant to the proposed question. These animal studies provided conflicting results. Whereas some support the use of SSD for treatment of partial-thickness burns, others question its effectiveness. For stasis dermatitis ulcer, the search identified 50 articles for review, of which 20 abstracts were reviewed, and one article met the inclusion criteria. This study did not show any significant improvement in the rate of complete healing in SSD group compared with placebo either at 4 weeks (relative risk 6.2, 95% confidence interval 0.8-48) or at 1 year (relative risk 5.2, 95% confidence interval 0.6-41.6) of follow-up.


CONCLUSIONS
There is insufficient evidence to either support or refute the routine use of SSD for ambulatory patients with either partial-thickness burns or stasis dermatitis ulcers to decrease mortality, prevent infection, or augment wound healing in human beings.
Miller
Andrew C
AC
Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
Rashid
Rashid M
RM
Falzon
Louise
L
Elamin
Elamin M
EM
Zehtabchi
Shahriar
S
D000287:Administration, Topical; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001458:Bandages; D002056:Burns / Q000175:diagnosis / Q000188:drug therapy*; D002642:Chick Embryo; D004195:Disease Models, Animal; D005500:Follow-Up Studies; D051379:Mice; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D018570:Risk Assessment; D012720:Severity of Illness Index; D012837:Silver Sulfadiazine / Q000627:therapeutic use*; D013552:Swine; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000188:drug therapy*; D014945:Wound Healing / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D012837:Silver Sulfadiazine