Last update Jan. 29, 2022

Sulfadiazine Silver

Low Risk

Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

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)


Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Sulfadiazine Silver is also known as

Sulfadiazine Silver in other languages or writings:


Main tradenames from several countries containing Sulfadiazine Silver in its composition:


Variable Value Unit
Oral Bioavail. Cut. Sd/Ag: 10/1; Oral Sd: 85 %
Molecular weight 357 daltons
Protein Binding 55 %
pKa 6.99 -
10 hours


  1. Choi H, Castillo B, Seminario-Vidal L. Silver absorption in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis treated with silver-impregnated dressings. A case series. Int Wound J. 2018 Dec;15(6):1049-1051. Abstract
  2. Brouillard C, Bursztejn AC, Latarche C, Cuny JF, Truchetet F, Goullé JP, Schmutz JL. Silver absorption and toxicity evaluation of silver wound dressings in 40 patients with chronic wounds. J Eur Acad Dermatol Venereol. 2018 Dec;32(12):2295-2299. Abstract
  3. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  4. AEMPS. Sulfadiazina argéntica. Ficha técnica. 2014 Full text (in our servers)
  5. Golshan M, Hossein N. Impact of ethanol, dry care and human milk on the time for umbilical cord separation. J Pak Med Assoc. 2013 Abstract
  6. Bristol. Silver Sulfadiazine. Drug Summary. 2012 Full text (in our servers)
  7. Moiemen NS, Shale E, Drysdale KJ, Smith G, Wilson YT, Papini R. Acticoat dressings and major burns: systemic silver absorption. Burns. 2011 Abstract
  8. Lewis N, Kolimarala V, Lander A. Conservative management of exomphalos major with silver dressings: are they safe? J Pediatr Surg. 2010 Abstract
  9. Fuller FW. The side effects of silver sulfadiazine. J Burn Care Res. 2009 Abstract
  10. Mintz EM, George DE, Hsu S. Silver sulfadiazine therapy in widespread bullous disorders: potential for toxicity. Dermatol Online J. 2008 Abstract
  11. Browning JC, Levy ML. Argyria attributed to silvadene application in a patient with dystrophic epidermolysis bullosa. Dermatol Online J. 2008 Abstract
  12. 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. 2006 Abstract
  13. Lansdown AB, Williams A. How safe is silver in wound care? J Wound Care. 2004 Abstract
  14. Pérez-Trallero E, Iglesias L. Tetraciclinas, sulfamidas y metronidazol. [Tetracyclines, sulfonamides and metronidazole]. Enferm Infecc Microbiol Clin. 2003 Nov;21(9):520-8; quiz 529, 533. Review. Spanish. Abstract Full text (link to original source)
  15. 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 Abstract Full text (link to original source) Full text (in our servers)
  16. 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. 2001 Feb;17(1):54-65. Abstract
  17. 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. 1995 Abstract
  18. Coombs CJ, Wan AT, Masterton JP, Conyers RA, Pedersen J, Chia YT. Do burn patients have a silver lining? Burns. 1992 Abstract
  19. Wan AT, Conyers RA, Coombs CJ, Masterton JP. Determination of silver in blood, urine, and tissues of volunteers and burn patients. Clin Chem. 1991 Abstract
  20. Boosalis MG, McCall JT, Ahrenholz DH, Solem LD, McClain CJ. Serum and urinary silver levels in thermal injury patients. Surgery. 1987 Abstract
  21. 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. 1985 Abstract
  22. Lockhart SP, Rushworth A, Azmy AA, Raine PA. Topical silver sulphadiazine: side effects and urinary excretion. Burns Incl Therm Inj. 1983 Abstract

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