Silver dressings and systemic toxicity: what’s the evidence?

Dr  Edward Siddens1, Dr Helen Douglas1, Dr  Edward Raby1, Professor Suzanne Rea1, Professor Fiona  Wood1

1State Burns Service WA


Silver is a transition metal, used in medicine since the 1800s to treat a wide range of conditions. The antimicrobial properties of ionic silver via its effects on DNA, cell membranes and cytochrome activity have led to the introduction of nano-crystalline silver dressings. These dressings have been widely accepted by the burns community to prevent and treat local wound infection, though in large burn injuries the systemic absorption of silver and its possible effects has raised concern.


We performed a literature search of Cochrane, PubMed, Medline and Google Scholar databases and retrieved 14 relevant articles; a mix of patient-based cohort and case studies and animal randomised control trials.


Current literature indicates that systemic absorption of silver occurs from silver-based dressings and that blood and urinary silver levels rise with increasing silver usage and %TBSA dressed. However, few adverse effects have been reported and no clear evidence of long terms side effects exists. Post mortem and animal studies have shown that silver deposition is most common in the lungs and kidneys. The benefit of taking serum silver levels in patients is unclear, as no standardised definition or criteria for silver toxicity exists, nor recognized treatment pathway.

Dr Edward Siddens is a registrar in plastics and burns surgery who has worked at the state adult burns service in WA

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