Sulfadiazine Silver

It is a sulfonamide used as a 1% cream for the prevention and treatment of infection in severe burns and leg ulcers.

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 ^{(Brouillard 2018, Choi 2018, 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 breastfeedingit 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.

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

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