Silver-containing dressings

The use of silver as an antibacterial has been known for centuries, but its topical use in antimicrobial dressings to prevent or treat infection in a wide range of acute and chronic wounds is relatively new. Extensive laboratory and clinical evaluations have shown the antibacterial value of silver dressings, although efficacy may be dependent on the properties of a silver dressing, of which there are a wide range available. However, a randomised controlled trial and two Cochrane systematic reviews and meta-analyses have concluded that there is insufficient evidence to show that silver dressings improve healing rates. This conclusion is flawed as silver dressings never were meant to heal wounds, only to facilitate control of bioburden.Topical antiseptics, including silver, are well suited to control of bioburden and biofilm when used in conjunction with adequate debridement, and no relevant microbial resistance has been found. The rise of antibiotic-resistant organisms makes the reintroduction of a wider use of topical antiseptics an attractive alternative when antibiotic stewardship controls inappropriate antibiotic use.Few adequate randomised clinical trials have been undertaken, and supportive laboratory findings do need to be interpreted carefully into clinical practice. Nevertheless, silver dressings have a clear role in the management of bioburden and biofilm in open wounds.