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- Oct 20, 2005
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Yesterday a patient came into my pharmacy with 3 rxs - for lorazepam, acyclovir and SSD 1% cream. I thought that these were a strange combo, but who knows - maybe she had a cold sore and a burn. While I was typing them in, the computer flagged both the lorazepam and SSD cream for allergies (to benzos and sulfa, respectively). We filled them and put a huge note to ask the patient before dispensing anything.
When the pt came in, I asked her about her allergies. She said that she was allergic to diazepam but she was OK with lorazepam (the first gave her hives, the second did not). OK, odd, but OK. When I asked about sulfas, she said that the last time she had anything with sulfa in it she had to have an epinephrine shot. I told her that we would call the doctor and ask for something else for her burn. She gave me a quizzical look and said, "Burn? I have shingles! And the itch is driving me crazy."
So I called the doctor (actually got the receptionist, Dr. M 😀) and asked for a substitution. The assistant said, "but the doctor says that SSD is really the best thing for shingles! What can we do?" I asked her to hold and talked to one of our pharmacists. The pharmacist agreed with me that SSD is really only for burns or wound care and said that my suggestion of hydroxyzine and hydrocortisone 2.5% would be a good start.
I mentioned these to the receptionist. She put me on hold and came back with sigs for the hydroxyzine and hydrocortisone from the MD (I never actually talked to the MD this entire time). We dispensed those to the patient along with some advice for dealing with shingles.
I still think that the MD prescribing SSD for shingles was odd, especially when itching was the pt's primary complaint. I looked up silver sulfadiazine in facts & comparisons, lexi-comp and micromedix. I couldn't find any indications anywhere except for in micromedix:
4.5.E Herpesvirus infection
1) Overview
FDA Approval: Adult, no; Pediatric, no
Efficacy: Adult, Evidence is inconclusive
Recommendation: Adult, Class III
Strength of Evidence: Adult, Category B
See Drug Consult reference: RECOMMENDATION AND EVIDENCE
Class III: Not Recommended: The given test, or treatment is not useful, and should be avoided.
Category B evidence is based on data derived from: Meta-analyses of randomized controlled trials with conflicting conclusions with regard to the directions and degrees of results between individual studies. Randomized controlled trials that involved small numbers of patients or had significant methodological flaws (e.g., bias, drop-out rate, flawed analysis, etc.). Nonrandomized studies (e.g., cohort studies, case-control studies, observational studies).
RATINGS
2) Summary:
SILVER SULFADIAZINE has been evaluated for herpes virus activity (Chang, 1975; Chang & Weinstein, 1975; Tokumaru et al, 1974). Although the product is often included in treatment regimens of patients with herpes (Vonderheid et al, 1980), it is unlikely that it will have any effect on the overall recurrence rate of herpes simplex (Jarrett et al, 1979).
3) Adult:
a) A marked reduction in symptoms was reported in 42 patients with herpes zoster following the application of SILVER SULFADIAZINE 1%. After application, the patients experienced complete drying of vesicles, marked reduction of erythema and edema, and striking elimination of pain and burning sensation within 24 to 72 hours. It is important to note that this study was not controlled (Montes et al, 1986a).
Apparently SSD is used for shingles, but the evidence for its use isn't great. So what do you guys think? Have you heard of SSD being used for shingles/herpes zoster? Did I do the right thing?
When the pt came in, I asked her about her allergies. She said that she was allergic to diazepam but she was OK with lorazepam (the first gave her hives, the second did not). OK, odd, but OK. When I asked about sulfas, she said that the last time she had anything with sulfa in it she had to have an epinephrine shot. I told her that we would call the doctor and ask for something else for her burn. She gave me a quizzical look and said, "Burn? I have shingles! And the itch is driving me crazy."
So I called the doctor (actually got the receptionist, Dr. M 😀) and asked for a substitution. The assistant said, "but the doctor says that SSD is really the best thing for shingles! What can we do?" I asked her to hold and talked to one of our pharmacists. The pharmacist agreed with me that SSD is really only for burns or wound care and said that my suggestion of hydroxyzine and hydrocortisone 2.5% would be a good start.
I mentioned these to the receptionist. She put me on hold and came back with sigs for the hydroxyzine and hydrocortisone from the MD (I never actually talked to the MD this entire time). We dispensed those to the patient along with some advice for dealing with shingles.
I still think that the MD prescribing SSD for shingles was odd, especially when itching was the pt's primary complaint. I looked up silver sulfadiazine in facts & comparisons, lexi-comp and micromedix. I couldn't find any indications anywhere except for in micromedix:
4.5.E Herpesvirus infection
1) Overview
FDA Approval: Adult, no; Pediatric, no
Efficacy: Adult, Evidence is inconclusive
Recommendation: Adult, Class III
Strength of Evidence: Adult, Category B
See Drug Consult reference: RECOMMENDATION AND EVIDENCE
Class III: Not Recommended: The given test, or treatment is not useful, and should be avoided.
Category B evidence is based on data derived from: Meta-analyses of randomized controlled trials with conflicting conclusions with regard to the directions and degrees of results between individual studies. Randomized controlled trials that involved small numbers of patients or had significant methodological flaws (e.g., bias, drop-out rate, flawed analysis, etc.). Nonrandomized studies (e.g., cohort studies, case-control studies, observational studies).
RATINGS
2) Summary:
SILVER SULFADIAZINE has been evaluated for herpes virus activity (Chang, 1975; Chang & Weinstein, 1975; Tokumaru et al, 1974). Although the product is often included in treatment regimens of patients with herpes (Vonderheid et al, 1980), it is unlikely that it will have any effect on the overall recurrence rate of herpes simplex (Jarrett et al, 1979).
3) Adult:
a) A marked reduction in symptoms was reported in 42 patients with herpes zoster following the application of SILVER SULFADIAZINE 1%. After application, the patients experienced complete drying of vesicles, marked reduction of erythema and edema, and striking elimination of pain and burning sensation within 24 to 72 hours. It is important to note that this study was not controlled (Montes et al, 1986a).
Apparently SSD is used for shingles, but the evidence for its use isn't great. So what do you guys think? Have you heard of SSD being used for shingles/herpes zoster? Did I do the right thing?
