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Prescribing Advice for GPs

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Evidence is poor for silver dressings

The Cochrane Library has published a review of the available evidence for topical silver for wounds. The aim of the analysis was to assess the efficacy of silver-containing wound dressings and topical agents in preventing wound infection and aiding healing of wounds.

The review identified 26 trials involving 2,066 participants. The studies were mainly conducted in patients with burns although 6 were conducted in non-burn wounds. The trials also varied in design by comparing silver-containing products to non-silver dressings, silver-containing dressings to silver-containing cream and one trial compared two types of silver dressing.

The review noted that the overall quality of the studies was poor. Half failed to report funding of the study and only three trials reported any details of the blinding process or the randomisation sequence.

The authors of this review conclude that, "there is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection". They also suggest that there is "not enough evidence to support the use of silver-containing dressings or creams". These conclusions are consistent with trial work published in the British Journal of Surgery.

Action: Clinicians should be aware of this review. Routine use of silver-containing dressings and topical agents should be avoided.

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4 Comments to “Evidence is poor for silver dressings”

  1. Hi,

    I am looking at silver dressing usage and wondered if you could point me in the right direction to get some figures on silver dressing use, in particular what percentage of silver dressings are used inappropriately i.e where actually a cheaper alternative could be used?

    I'd grateful for some information or a point in the right direction.



    Comment by Jay owen — May 26, 2011 #

    1. @Jay,

      Such information would need a clinical assessment at an individual patient level. As such obtaining such information would need individual patient consent. I'm not aware of any such information at this level.

      Comment by Matthew Robinson — May 26, 2011 #

  2. i am not objective, but you have to absolutely blind not to see the advantages of silver dressings. not only is their silver load a small fraction of the SSD/Flamazine thats been the standard for 50 years, but these dressings are far less taxing on the patient and the care giver.

    i do not disagree that the published material lacks rigor, but to extrapolate the conclusion that these dressings should be avoided is irresponsible and also unsupported.

    you have done yourself a great disservice at every reasonable level of inquiry.

    Comment by gregg silver — March 31, 2010 #

    1. @Gregg,

      Thanks for your comment. I wonder why you think I've done myself a disservice in quoting rigourous analysis of published evidence.

      You obviously feel strongly that Silver dressings are a great benefit yet you admit that the current published evidence has systematically failed to demonstrate a benefit. The only reasonable conclusion therefore is that the use of silver dressings is unsupported by medical evidence.

      Until reliable evidence is produce to support the advantages you suspect that silver dressings provide, this will always be the case. Assumed advantages may not hold true in real world use. For example, just because the small levels of silver at antimicrobial in a test tube on a lab bench does not mean they will be when applied to a would on a living breathing human being.

      Comment by Matthew Robinson — April 2, 2010 #

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