Use of silver dressing in burn cases questioned

By Candy Lashkari

The use of expensive silver dressing in burn cases is being brought under the scanner by an editorial in the Drug and Therapeutics Bulletin. The NHS has increased its spending from £23 million in 2005 to around £25 million in 2006/7 on such products. The author asks if expensive silver dressing is really justified when cheaper alternatives are available.

"Silver dressings are expensive and there have been few high-quality clinical trials to establish whether they have advantages over other, cheaper, alternatives," says the Bulletin. “Most of the studies that have been conducted have had considerable methodological limitations.”

Dr Andrew Jull from New Zealand who is a clinical epidemiologist at the University of Auckland tends to agree with the evaluation. "This is a well reasoned description of the evidence base for silver dressings. Silver is anti-bacterial in bench-top terms but when it comes to real patients, the quality of evidence is very low" says Jull.

However Dr Jull also believes that silver dressings should not be used routinely in leg ulcers and diabetic foot ulcers. According to him it should be a second choice and not a first line treatment. Destruction of skin in serious burns may merit the use of silver dressings but he wonders if antibiotics may be as effective for the treatment of the burns.

Professor Roy Kimble who is the director of burns and trauma at the Royal Children Hospital in Brisbane feels that the use of silver dressings is totally justified. "The vast majority of burns surgeons in Australia use silver dressings. It's a special silver lattice, which you add water to and it releases silver atom ions and silver atoms. Silver ions kill bacteria and silver atoms almost certainly work as an anti-inflammatory. Both of which are very good for burn wound healing." says Professor Roy Kimble.

Professor Kimble has been associated with a number of studies on the nano-crystalline silver dressing used by most burn units in Australia and he says that using the silver dressing actually reduces the burn wound infection. Plus he finds that the silver dressing is more cost effective as it does not need to be changed as often as other dressings do.

Also since evaluation of other types of dressings will increase the risk of burn wound infection he feels that it would be simply not ethical to provide burn patients with other dressings to conduct a study.