A Cochrane review from 2008 did not recommend silver sulfadiazine, an ointment containing silver, for burns as it potentially prolongs healing time.^[1] It however used to be deemed the "gold standard" in topical treatment.^[2] A 2012 review found no advantage when an anti-microbial (silver) hydrocolloid dressing was compared with a standard alginate dressing in diabetic foot ulcers.^[3] There is insufficient evidence to support the use ofsilvercontaining dressings.^[4]These dressings sometimes result in a slower healing process.^[2] The evidence for their use is marred by the poor quality of the trials.^[5] Most of the studies have been small and they generally indicated that the treatments did not promote wound healing or prevent wound infections.^[6][7]

Silver sulfadiazine cream replaced colloidal silver as the most common delivery system for using silver on the surface of burn wounds to control infection in the 1970s.^[8][2] The US Food and Drug Administration has approved topical preparations of silver sulfadiazine for treatment of second- and third-degree burns.^[9]

Dressings incorporating nanocrystalline silver or activated silver-impregnated substances are available,^[2] which deliver higher concentrations of the active silver ion.^[10] As of 2006, more "than 10 dressings containing pure silver" were available.^[11] In particular, silver is being used with alginate, a naturally occurring biopolymer derived from seaweed, in a range of products designed to prevent infections as part of wound management procedures, particularly applicable to burn.^[11]

Topical silver is regaining popularity in the management of open wounds, “due largely to the spread of methicillin-resistant Staphylococcus aureus and the resultant reduction in first-line antibiotic prescribing”, and “[s]ome silver-based dressings appear to provide an effective alternative to antibiotics in the management of wound infection.”^[12] Silver has broad-spectrum antimicrobial activity that includes antibiotic-resistant bacteria, with minimal toxicity toward mammalian cells at low concentrations, and has a less likely tendency than antibiotics to induce resistance due to its activity at multiple bacterial target sites.^[13]