REVIEW Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers Andrew C. Miller, MD, a,b Rashid M. Rashid, MD, PhD, c Louise Falzon, MLIS, d Elamin M. Elamin, MD, MSc, e and Shahriar Zehtabchi, MD f Bethesda, Maryland; Pittsburgh, Pennsylvania; Houston, Texas; New York, New York; and Tampa, Florida 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. Conclusion: 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. ( J Am Acad Dermatol 10.1016/j.jaad.2010.06.014.) Key words: burns; silver sulfadiazine; stasis dermatitis ulcer; wounds and injuries F or centuries man has exploited the medicinal properties of silver-containing compounds. Historically, silver was noted to render water potable. 1 Silver compounds were popular remedies for tetanus and rheumatism in the 19th century, and used to treat colds and gonorrhea before the advent of more modern antibiotics in the early 20th century. Around World War II, interest in therapeutic silver waned. Later, silver nitrate was proposed as a treat- ment for burn wounds. 2 The ensuing search to improve upon silver nitrate’s drug profile culminated in a landmark article by Fox 3 in 1968 describing the formulation and use of silver sulfadiazine (SSD). Soon after, SSD gained popularity becoming the standard treatment for partial-thickness burns to prevent or treat infection and augment wound heal- ing. However, SSD use continued based on anec- dotal results. To date, little clarity exists on whether From the Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda a ; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center b ; Department of Dermatology, University of Texas M. D. Anderson Cancer Center c ; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York d ; Department of Pulmonary, Critical Care, and Sleep Medicine, James A. Haley Veterans Hospital, Tampa e ; and Department of Emergency Medicine, State University of New York Downstate Medical Center and Kings County Hospital Center. f Funding sources: None. Conflicts of interest: None declared. Reprint requests: Rashid M. Rashid, MD, PhD, 6655 Travis, Suite 980, Houston, TX 77030. E-mail: rashidrashid.mdphd@yahoo. com. Published online August 17, 2010. 0190-9622/$36.00 ª 2010 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2010.06.014 e1 ARTICLE IN PRESS