What is Silver Sulfonamide Cream Used For? A Guide to Burn and Wound Care

October 6, 2025 •

4 min read

Each year in the United States, there are approximately 450,000 burn injuries that require medical treatment. For serious burns, a key question for clinicians and patients is, what is silver sulfonamide cream used for? This topical antibiotic is a primary tool for preventing and treating wound infections in second- and third-degree burns.

Quick Summary

Silver sulfonamide cream, commonly known as silver sulfadiazine (SSD), is a prescription topical antibiotic primarily used to prevent and treat infections in patients with second- and third-degree burns.

Key Points

Primary Use: Silver sulfonamide cream is mainly used to prevent and treat wound infections in patients with second- and third-degree burns.
Mechanism: It works by combining the effects of silver and sulfadiazine to act on the bacterial cell wall and membrane, stopping bacterial growth.
Application: The cream should be applied with a sterile glove in a layer that covers the entire burn surface, on a schedule determined by a healthcare provider.
Prescription Only: This medication is available only by prescription and should be used under the guidance of a healthcare provider.
Contraindications: It should not be used by individuals with sulfa allergies, pregnant women near term, or infants under 2 months of age.
Side Effects: Common side effects include local itching and burning. More serious but rare side effects related to sulfa absorption can occur, like blood disorders.
Alternatives Exist: Other treatments like bacitracin for minor burns, mafenide acetate for deep burns, and honey-based dressings are used depending on the wound type.

Understanding Silver Sulfonamide Cream

Silver sulfadiazine (SSD), often known by brand names like Silvadene® or Thermazene®, is a prescription antibiotic cream. It has been a cornerstone of topical burn care since it was approved by the FDA in 1973. Its main purpose is to prevent and treat wound sepsis (infection) in patients suffering from second- and third-degree burns. By controlling the growth of bacteria, the cream helps reduce the risk of an infection spreading to the surrounding skin or into the bloodstream, which could lead to a life-threatening condition called sepsis. While its primary FDA-approved use is for burns, clinicians sometimes use it 'off-label' for other skin infections like ulcers. It belongs to a class of drugs known as sulfa antibiotics.

How Does It Work? The Mechanism of Action

The effectiveness of silver sulfadiazine stems from the combined action of its two components: silver and sulfadiazine. The mechanism is different from that of silver nitrate or sodium sulfadiazine alone. The cream acts on the bacterial cell membrane and cell wall to exert its bactericidal (bacteria-killing) effect. The silver ions bind to various components in the bacterial cells, including DNA and key proteins, which inhibits DNA replication and disrupts essential functions like respiration, ultimately leading to cell death. The sulfadiazine component, a sulfonamide antibiotic, interferes with the bacteria's ability to synthesize folic acid, a vital nutrient for its growth and replication. This dual action provides a broad spectrum of activity against many common burn wound pathogens, including both gram-positive and gram-negative bacteria and some yeasts like Candida albicans.

Proper Application

Correct application is crucial for the medication's efficacy and safety. Silver sulfadiazine should only be used externally and as directed by a healthcare provider.

Clean the Area: Before application, the burn wound must be gently cleansed and debrided (removal of dead tissue) by a healthcare professional.
Use Sterile Technique: Always wear sterile, disposable gloves when applying the cream to prevent introducing new bacteria to the wound. Each tube or tub of cream should be designated for a single patient to avoid cross-contamination.
Apply a Layer: The cream should be applied in a layer that covers the entire burn surface as directed by a healthcare professional.
Maintain Coverage: The burn area must be kept covered with the cream at all times, typically requiring application on a regular schedule determined by a healthcare provider. If the cream is rubbed off by clothing or activity, it should be reapplied as instructed.
Continue Treatment: Treatment should continue until the wound has healed satisfactorily or is ready for a skin graft, as directed by a doctor. Stopping the medication too early can increase infection risk, while using it for too long may potentially slow wound healing.

Dressings are not always required but can be used if necessary to keep the area covered with medication.

Potential Side Effects and Important Precautions

While effective, silver sulfadiazine can cause side effects. Common, localized effects include pain, burning, or itching at the application site. A brownish-gray skin discoloration may also occur.

More serious, though less common, side effects can occur because the sulfadiazine component can be absorbed into the bloodstream, especially when used on large burn areas. These potential side effects are similar to those of other sulfa drugs and include:

Blood Disorders: A temporary decrease in white blood cells (leukopenia) is a known side effect, often occurring in the first few days of therapy and usually resolving on its own. Other rare but serious disorders include agranulocytosis and aplastic anemia.
Severe Skin Reactions: In rare cases, life-threatening skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can occur.
Kidney or Liver Issues: Patients with pre-existing liver or kidney impairment should use the cream with caution, as accumulation of the drug can occur.

Contraindications: Silver sulfadiazine is contraindicated in patients with a known hypersensitivity to sulfa drugs. It must not be used on premature infants, newborns under 2 months of age, or pregnant women who are near term, due to the risk of a condition called kernicterus (a type of brain damage) in the infant.

Comparison with Other Topical Burn Treatments

Silver sulfadiazine is just one of several options for topical burn care. Its place in therapy depends on the burn's severity, location, and physician preference.


Treatment	Primary Use	Pros	Cons
Silver Sulfadiazine (SSD)	Second- and third-degree burns to prevent infection.	Broad-spectrum antimicrobial, soothing, painless application.	Sulfa allergy risk, may impair wound healing, requires frequent application, can form a pseudoeschar.
Bacitracin / Polysporin	Minor burns and cuts.	Available over-the-counter, few side effects. Preferred for partial-thickness burns as it avoids painful pseudoeschar removal.	Not for deep or large wounds, less potent than SSD.
Mafenide Acetate	Deep burns, especially over cartilage (ears, nose).	Excellent penetration of eschar (dead tissue).	Can cause metabolic acidosis, application can be painful.
Honey-Based Dressings	Superficial and partial-thickness burns.	May promote faster healing and render wounds sterile more effectively than SSD in some studies.	Evidence quality varies; not a standard for severe or complex burns.
Aloe Vera	First- and second-degree burns.	Studies suggest it may accelerate re-epithelialization and offer pain relief compared to SSD. Less expensive.	Less established for third-degree burns; efficacy depends on preparation.

Conclusion

So, what is silver sulfonamide cream used for? It is a critically important prescription medication for the prevention and treatment of infection in serious second- and third-degree burns. Its bactericidal action helps protect patients from life-threatening sepsis during the vulnerable healing process. However, its use requires careful medical supervision due to potential side effects and contraindications, particularly for those with sulfa allergies and in specific patient populations like infants. As research evolves, other treatments like honey-based dressings and advanced skin substitutes are also finding their place in burn care, offering alternatives that may be better suited for certain types of wounds. The choice of treatment always depends on a thorough evaluation by a healthcare professional.

For more information on the use of this and other medications, an authoritative resource is MedlinePlus, a service of the National Library of Medicine.

Frequently Asked Questions

Yes, silver sulfadiazine cream is specifically designed for use on open wounds caused by second- and third-degree burns to prevent and treat infection, as directed by a healthcare provider.

You should use the cream for as long as your doctor instructs. Typically, this is until the burn has healed sufficiently or is ready for skin grafting.

Yes, silver sulfadiazine is a sulfa antibiotic. It should not be used by anyone with a known allergy to sulfa drugs.

Silver sulfadiazine is approved for second- and third-degree burns. A mild sunburn is a first-degree burn and is typically treated with aloe vera. If a sunburn is severe, with blistering or open skin, it may be considered a second-degree burn, and a doctor should be consulted on whether SSD is appropriate.

Silvadene is a common brand name for the generic medication silver sulfadiazine cream. Other brand names include SSD Cream and Thermazene.

While the cream itself can have a soothing effect upon application, its primary purpose is to prevent infection, not to act as a pain reliever. Pain, burning, and itching are also listed as potential side effects.

Silver sulfadiazine is contraindicated in infants under 2 months of age and premature babies because the absorbed sulfonamide can cause kernicterus, a serious form of brain damage resulting from high bilirubin levels.