Yes

Antibiotic, Ophthalmic; Antibiotic, Topical; Cauterizing Agent, Topical; Topical Skin Product, Antibacterial

Prevention of gonococcal ophthalmia neonatorum; cauterization of wounds and sluggish ulcers, removal of granulation tissue and warts; aseptic prophylaxis of burns

C

Not for use on broken skin or cuts; hypersensitivity to silver nitrate or any component

Do not use applicator sticks on the eyes; repeated applications of the ophthalmic solution into the eye can cause cauterization of the cornea and blindness

>10%:

Dermatologic: Burning and skin irritation

Ocular: Chemical conjunctivitis

1% to 10%:

Dermatologic: Staining of the skin

Hematologic: Methemoglobinemia

Ocular: Cauterization of the cornea, blindness

Symptoms of overdose include pain and burning of mouth, salivation, vomiting, diarrhea, shock, coma, convulsions, death; blackening of skin and mucous membranes; absorbed nitrate can cause methemoglobinemia

Fatal dose is as low as 2 g

Administer sodium chloride in water (10 g/L) to cause precipitation of silver

Decreased effect: Sulfacetamide preparations are incompatible

Must be stored in a dry place; exposure to light causes silver to oxidize and turn brown, dipping in water causes oxidized film to readily dissolve

Free silver ions precipitate bacterial proteins by combining with chloride in tissue forming silver chloride; coagulates cellular protein to form an eschar; silver ions or salts or colloidal silver preparations can inhibit the growth of both gram-positive and gram-negative bacteria. This germicidal action is attributed to the precipitation of bacterial proteins by liberated silver ions. Silver nitrate coagulates cellular protein to form an eschar, and this mode of action is the postulated mechanism for control of benign hematuria, rhinitis, and recurrent pneumothorax.

Absorption: Because silver ions readily combine with protein, there is minimal GI and cutaneous absorption of the 0.5% and 1% preparations

Elimination: Although the highest amounts of silver noted on autopsy have been in the kidneys, excretion in urine is minimal

Neonates: Ophthalmic: Instill 2 drops immediately after birth (no later than 1 hour after delivery) into conjunctival sac of each eye as a single dose, allow to sit for greater than or equal to 30 seconds; do not irrigate eyes following instillation of eye drops

Children and Adults:

Ointment: Apply in an apertured pad on affected area or lesion for approximately 5 days

Sticks: Apply to mucous membranes and other moist skin surfaces only on area to be treated 2-3 times/week for 2-3 weeks

Topical solution: Apply a cotton applicator dipped in solution on the affected area 2-3 times/week for 2-3 weeks

With prolonged use, monitor methemoglobin levels

No information available to require special precautions

No effects or complications reported

Use as directed; do not use more often than instructed. Store container in dry, dark place.

Sticks: Apply to mucous membranes and other moist skin surfaces to be treated 2-3 times each week for 2-3 weeks.

Solution: Apply to affected area with cotton applicator dipped in solution 2-3 times each week for 2-3 weeks.

Handle with care; silver nitrate stains skin, clothing and utensils. Discontinue and contact prescriber if treated areas worsen or if redness, or irritation develops in surrounding area. Pregnancy precautions: Inform prescriber if you are or intend to be pregnant.

Silver nitrate solutions stain skin and utensils

Applicator sticks: 75% with potassium nitrate 25% (6")

Ointment: 10% (30 g)

Solution:

Ophthalmic: 1% (wax ampuls)

Topical: 10% (30 mL); 25% (30 mL); 50% (30 mL)

Cushing AH and Smith S, "Methemoglobinemia With Silver Nitrate Therapy of a Burn: Report of a Case," J Pediatr, 1969, 74(4):613-5.

Hammerschlag MR, Cummings C, Roblin PM, et al, "Efficacy of Neonatal Ocular Prophylaxis for the Prevention of Chlamydial and Gonococcal Conjunctivitis," N Engl J Med, 1989, 320(12):769-72.

U.S. Department of Health and Human Services, "1993 Sexually Transmitted Diseases Treatment Guidelines," MMWR Morb Mortal Wkly Rep, 1993, 42(RR-14).