The use of expensive silver wound dressings should be shelved until the evidence suggests otherwise, says Drug and Therapeutics Bulletin, following a review on the evidence of their effectiveness.
These include many silver-releasing, so-called “advanced,” dressings, which were originally developed to curb infection in wounds that are difficult to heal, chronic leg ulcers, and widespread burns.
The use of these dressings has become widespread around the world in recent years. And in 2006/7, they cost the NHS alone £25 million — £2 million more than in 2005 and equivalent to a quarter of the total cost of all wound dressings.
Yet the clinical evidence that such dressings work is thin, and certainly not enough to prove they work any better than conventional and considerably cheaper dressings, says DTB.
“Silver dressings are expensive and there have been few high quality trials to establish whether they have advantages over other, cheaper alternatives,” it says.
Sample sizes have frequently been small, trial length short — typically between 3 and 8 weeks — and assessors or participants not necessarily blinded to the treatment being used — considered essential for reducing potential bias, it says.
“With these factors in mind, we believe that the routine use of silver dressings is not justified on clinical or cost-effectiveness grounds as treatment for uncomplicated leg ulcers, when simple dressings and compression bandaging are more appropriate,” it continues.
Nor are silver dressings suitable for acute wounds, says DTB, as there is some evidence, albeit weak, to suggest that these dressings can actually delay rather than speed up healing.
“There is a better case for using silver dressings for patients with infected burns, but even, here, the evidence base is weak,” it says, concluding: “Overall, the amount currently spent in the NHS on silver dressings appears difficult to justify in the light of the existing data.”
Silver dressings – do they work? DTB 2010; 48: 38-42