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Informational/Educational Report
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Clinical work with silver dressings: is this really evidence-based medicine? Michel H.E. Hermans, MD A significant number of silver dressings have been introduced to the wound care market: based on the fact that they contain silver, they all are claimed to have broad spectrum antimicrobial efficacy and to provide good wound healing properties. However, actual proof of these claims is not always very scientifically sound. .For example, some of the in vivo studies on bacteriology are done with wound models that are not representative of the clinical situation (ie, testing silver concentration in distilled water, in which silver ions cannot precipitate as AgCl) With respect to clinical ÒproofÓ of efficacy, little research has been done in controlled, comparative clinical trials. For example, of a total of 243 poster presented during the 2005 SAWC meeting, 38 (16%) were on silver products, but only 5 (2% of the total) were on clinical trials that were done with appropriate protocols, inclusion and exclusion criteria, and statistics. Most trials are, in fact, a series of case studies (without comparators and/or statistical analysis). A web search on a specific indication, partial thickness burns, showed similar results: of 355 hits (articles published after 1995, keywords including ÒsilverÓ, ÒburnsÓ, brand names, etc.), only 4 (5%) were on prospective, randomized, clinical trials using appropriate and relevant protocols and statistics Thus, it is fair to say that, for most silver containing dressings, true clinical evidence of efficacy has not been shown, at least not in, what is generally considered, the golden standard, controlled, clinical, comparative trials. It is the responsibility of manufacturers and health care providers to create and use true evidence: without it, evidence based medicine in wound care cannot be offered. |
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