Silver-containing treatments are popular and used in
wound treatments to combat a broad spectrum of pathogens, but evidence of their effectiveness in preventing
wound infection or promoting healing is lacking.
OBJECTIVES: Randomised controlled trials (RCTs) comparing
silver-containing
wound dressings and topical agents with
silver-containing and non
silver-containing comparators on uninfected
wounds.
DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed risk of bias, and extracted data.
MAIN RESULTS: We identified 26 RCTs (2066 patients). Heterogeneity of treatments and outcomes precluded meta-analysis. We grouped results according to
wound type, and
silver preparation.BurnsThirteen trials compared topical
silver (in a variety of formulations - including
silver sulphadiazine (
SSD) cream) with non-
silver dressings. One trial showed fewer
infections with
silver nitrate when compared with a non-
silver dressing, but three trials showed significantly more
infection with
SSD than with the non-
silver dressing.Six trials compared
SSD cream with
silver-containing dressings. One showed significantly fewer
infections with the
silver-containing dressing (Hydron AgSD) compared with
SSD, the remaining five found no evidence of a difference.One trial compared two
silver-containing dressings, and showed a significantly lower
infection rate with
silver-coated gauze (
Acticoat(R)) than with
silver nitrate gauze.Other woundsSix trials compared
SSD/
silver-containing dressings with non-
silver dressings (nine dressings in total). Most comparisons (seven) found no significant differences in
infection rates; one trial in a variety of
wounds exhibited significantly fewer
infections with
SSD/
hydrocolloid, but another, in acute
wounds, found significantly more
infections with
SSD. Only one comparison showed a significant reduction in healing time associated with a
silver-containing hydrofibre dressing in
diabetic foot ulcers.
AUTHORS' CONCLUSIONS: There is insufficient evidence to establish whether
silver-containing dressings or topical agents promote wound healing or prevent
wound infection; some poor quality evidence for
SSD suggests the opposite.