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There is a large selection of antimicrobial dressings on the formulary, silver should be considered as a final option.
Antimicrobial dressings containing silver should be used only when infection is suspected as a result of clinical signs or symptoms
It is recommended that these dressings should not be used on acute wounds as there is some evidence to suggest they delay wound healing. There is little evidence of the efficacy of silver against anaerobes, although these are often present in chronic wounds.
There is no evidence to support the use of silver dressings under compression bandaging for the healing of venous leg ulcers when compared with non-silver low adherent dressings.
Silver-impregnated dressings should not be used routinely for the management of uncomplicated ulcers.
The two-week challenge
Silver ions exert an antimicrobial effect in the presence of wound exudate; the volume of wound exudate as well as the presence of infection should be considered when selecting a silver-containing dressing.
High deposits of silver can have a toxic effect on internal organs and there is evidence for bacterial resistance.
Silver can permanently stain the skin (argyria) and will reduce keratinocyte (skin) production.