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A Cochrane review from 2008 did not recommend silver sulfadiazine, an ointment containing silver, for burns as it potentially prolongs healing time. It however used to be deemed the "gold standard" in topical treatment. A 2012 review found no advantage when an anti-microbial (silver) hydrocolloid dressing was compared with a standard alginate dressing in diabetic foot ulcers. There is insufficient evidence to support the use ofsilvercontaining dressings. These dressings sometimes result in a slower healing process. The evidence for their use is marred by the poor quality of the trials. Most of the studies have been small and they generally indicated that the treatments did not promote wound healing or prevent wound infections.

Silver sulfadiazine cream replaced colloidal silver as the most common delivery system for using silver on the surface of burn wounds to control infection in the 1970s. The US Food and Drug Administration has approved topical preparations of silver sulfadiazine for treatment of second- and third-degree burns.

Dressings incorporating nanocrystalline silver or activated silver-impregnated substances are available, which deliver higher concentrations of the active silver ion. As of 2006, more "than 10 dressings containing pure silver" were available. In particular, silver is being used with alginate, a naturally occurring biopolymer derived from seaweed, in a range of products designed to prevent infections as part of wound management procedures, particularly applicable to burn.

Topical silver is regaining popularity in the management of open wounds, “due largely to the spread of methicillin-resistant Staphylococcus aureus and the resultant reduction in first-line antibiotic prescribing”, and “[s]ome silver-based dressings appear to provide an effective alternative to antibiotics in the management of wound infection.” Silver has broad-spectrum antimicrobial activity that includes antibiotic-resistant bacteria, with minimal toxicity toward mammalian cells at low concentrations, and has a less likely tendency than antibiotics to induce resistance due to its activity at multiple bacterial target sites.