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The medical uses of silver include its incorporation into wound dressings, and its use as an antibiotic coating in medical devices. Silver is also promoted within alternative medicine in the form of colloidal silver, although it has not been shown to be safe or effective.

While wound dressings containing silver sulfadiazine or silver nanomaterials may be used to treat external infections, there is little evidence to support their use. Silver is also used in some medical applications, such as urinary catheters and endotracheal breathing tubes, where there is tentative evidence that it is effective in reducing catheter-related urinary tract infections and ventilator-associated pneumonia respectively. The silver ion (Ag
) is bioactive and in sufficient concentration readily kills bacteria in vitro. Liquid sprays containing nano-silver are effective as a hard-surface disinfectant.

Historically "colloidal silver", a liquid suspension of microscopic silver particles, was ingested to treat a variety of diseases. Its use was largely discontinued in the 1940s, following the development of safer and more effective modern antibiotics. Since the 1990s, the ingestion of colloidal silver has again been marketed as an alternative medicine, often with extensive "cure-all" claims. Colloidal silver products remain legally available as dietary supplements or homeopathic remedies, although they are not effective for any known condition and carry the risk of serious side effects.

Medical uses

Dressings

Silver sulfadiazine (SSD) was developed in 1968, and Lansdown noted in 2010 that SSD is the most popular antibiotic for topical application in burn and scald clinics, that it is particularly effective in treating Pseudomonas aeruginosa and that it has a relatively low health risk threshold. By 2007 it was regarded as the "gold standard" in topical treatment. The US Food and Drug Administration has approved a number of topical preparations of silver sulfadiazine for treatment of second- and third-degree burns. Lansdown further states that "most clinical trials" have shown that silver-based dressings demonstrate "commendable levels of antimicrobial action and improved wound healing", but that "the Cochrane Collaboration is concerned that appropriate criteria for patient and wound evaluation are lacking" and that more data is needed to establish the relative values of the various available dressings.

A Cochrane collaboration review of studies conducted up to 2008 stated that "the evidence, which largely derives from trials with methodological shortcomings, is of limited usefulness ..." Another Cochrane collaboration review of studies conducted up to 2009 concluded that "There is insufficient evidence to establish whether silver-containing dressings or topical agents promote wound healing or prevent wound infection". Other reviews of the evidence have also concluded that the "quality of the trials was limited". Cochrane has also raised concerns about delays in time to wound healing and an increased number of dressing applications.

Dressings incorporating nanocrystalline silver or activated silver-impregnated substances are available which deliver higher concentrations of the active silver ion. Nanocrystalline silver barrier dressings promote healing and reduce inflammatory wound changes. 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 burns.

Topical silver has been shown to be efficacious in controlling most pathogenic bacteria, including methicillin-resistant Staphylococcus aureus, and "ome silver-based dressings appear to provide an effective alternative to antibiotics in the management of wound infection." 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.

A 2012 review of six studies found no advantage when an anti-microbial (silver) hydrocolloid dressing was compared with a standard alginate dressing in treating diabetic foot ulcers.

Endotracheal tubes

Ventilator-associated pneumonia (VAP) has a very high rate of mortality, and the associated costs are high. Studies on Endotracheal breathing tubes coated with silver have shown a significant reduction in the incidence of VAP, although in the studies thusfar undertaken, no benefit was seen on the duration of intubation, the duration of stay in intensive care or the mortality rate. The U.S. Food and Drug Administration in 2007 approved an endotracheal tube with a fine coat of silver to reduce the risk of ventilator-associated pneumonia.

Urinary catheters

Tentative evidence supports a decreased risk of urinary tract infections when silver-alloy catheters are used. Their cost effectiveness is uncertain as of 2008.

Anti-smoking aid

Silver acetate has been used as a potential aid to help stop smoking. A review of the literature in 2012 however found no effect of silver acetate on smoking cessation at a six month endpoint and if there is an effect it would be small.

Antiseptic use

Silver compounds are used in external preparations as antiseptics, including both silver nitrate and silver proteinate, which can be used in dilute solution as eyedrops to prevent conjunctivitis in newborn babies. Silver nitrate is also sometimes used in dermatology in solid stick form as a caustic ("lunar caustic") to treat certain skin conditions, such as corns and warts. Liquid sprays containing silver may be used as a hard-surface disinfectant. Ionizable silver has been incorporated into fabrics to reduce the spread of bacteria. Silver is also used in bone prostheses, reconstructive orthopedic surgery and cardiac devices.

Adverse effects

In animals and humans, silver accumulates in the body. Chronic intake of silver products can result in an accumulation of silver or silver sulfide particles in the skin. These particles in the skin darken with exposure to sunlight, resulting in a blue or gray discoloration of the skin known as argyria. Localized argyria can occur as a result of topical use of silver-containing solutions, while generalized argyria results from the ingestion of such substances.

Argyria is generally believed to be irreversible, with the only practical method of minimizing its cosmetic disfigurement being to avoid the sun, but laser therapy has been used to treat it with satisfactory cosmetic results. The Agency for Toxic Substances and Disease Registry (ATSDR) describes argyria as a "cosmetic problem", but medical literature from 1935 and 1940, when argyria occurred more frequently, emphasizes it as a socially debilitating condition.

While argyria is usually limited to skin discoloration, there are isolated reports of more serious neurologic, renal, or hepatic complications caused by ingesting colloidal silver.

Colloidal silver may interact with some prescription medications, reducing the absorption and effectiveness of tetracyclines, quinolone antibiotics, levothyroxine, and penicillamine.

The use of these devices is contraindicated for persons who are allergic to silver, and although they are widely used in hospitals, no thorough testing and standardization of these products has yet been undertaken.

Water purification

Electrolytically-dissolved silver has been used as a water disinfecting agent, for example, the drinking water supplies of the Russian Mir orbital station and the International Space Station. Many modern hospitals filter hot water through copper-silver filters to defeat MRSA and legionella infections. The World Health Organization includes silver in a colloidal state produced by electrolysis of silver electrodes in water, and colloidal silver in water filters as two of a number of water disinfection methods specified to provide safe drinking water in developing countries. Along these lines, a ceramic filtration system coated with silver particles has been created by Ron Rivera of Potters for Peace and used in developing countries for water disinfection (in this application the silver inhibits microbial growth on the filter substrate, to prevent clogging, and does not directly disinfect the filtered water).

Mechanism of action

Silver and most silver compounds have an oligodynamic effect and are toxic for bacteria, algae, and fungi in vitro. The oligodynamic effect is typical for heavy metals, such as lead and mercury, but, among the elements that have this effect, silver is the least toxic for humans. The antibacterial action of silver is dependent on the silver ion. The effectiveness of silver compounds as an antiseptic is based on the ability of the biologically active silver ion (Ag
) to irreversibly damage key enzyme systems in the cell membranes of pathogens. The antibacterial action of silver has long been known to be enhanced by the presence of an electric field. Applying an electric current across silver electrodes enhances antibiotic action at the anode, likely due to the release of silver into the bacterial culture. The antibacterial action of electrodes coated with silver nanostructures is greatly improved in the presence of an electric field.

Alternative medicine

Since about 1990, there has been a resurgence of the promotion of the ingestion of colloidal silver as an alternative medicine treatment, marketed with claims of it being an essential mineral supplement, or that it can prevent or treat numerous diseases, such as cancer, diabetes, HIV/AIDS, and herpes, as well as tuberculosis. No medical evidence supports the ingestion of colloidal silver as being effective for any of these claimed indications, and some clinical studies in humans demonstrate toxicity. Silver is not an essential mineral in humans; there is no dietary requirement for silver, and no such thing as a silver "deficiency".

The commercial product referred to as "colloidal silver" includes solutions that contain various concentrations of ionic silver compounds, silver colloids or silver compounds bound to proteins in water. Such products with concentrations of 30 parts per million (ppm) or less are typically manufactured using electrolysis, whereas those with concentrations of 50 ppm or more are usually silver compounds that have been bound with a protein. Colloidal silver preparations primarily deliver inactive metallic silver, rather than the active microbicidal silver ion.

In August 1999, the FDA banned colloidal silver sellers from claiming any therapeutic or preventive value for the product, noting colloidal silver was being marketed for numerous diseases without evidence of safety or effectiveness. As a result, the product now has the status of a dietary supplement in the US; it can be promoted with general "structure-function" claims, but cannot be marketed as preventing or treating any illness. Following this ruling, the FDA has issued numerous Warning Letters to Internet sites that have continued to promote colloidal silver as an antibiotic or for other medical purposes. In 2002, the Australian Therapeutic Goods Administration (TGA) found there were no legitimate medical uses for the ingestion of colloidal silver and no evidence to support its marketing claims. Given the associated safety risks, the TGA concluded "efforts should be made to curb the illegal availability of colloidal silver products, which is a significant public health issue." The U.S. National Center for Complementary and Alternative Medicine has issued an advisory indicating the marketing claims made about the ingestion of colloidal silver are scientifically unsupported, the silver content of marketed supplements varies widely, and ingesting colloidal silver products can have serious side effects such as argyria.

Environmental effects

Silver that enters the environment from discarded medical sources can have detrimental effects on micro-organisms and animals (including humans).

History

Hippocrates in his writings discussed the use of silver in wound care. At the beginning of the twentieth century surgeons routinely used silver sutures to reduce the risk of infection. In the early 20th century, physicians used silver-containing eyedrops to treat ophthalmic problems, for various infections, and sometimes internally for diseases such as tropical sprue, epilepsy, gonorrhea, and the common cold. During World War I, soldiers used silver leaf to treat infected wounds.

Prior to the introduction of modern antibiotics, colloidal silver was used as a germicide and disinfectant. With the development of modern antibiotics in the 1940s, the use of silver as an antimicrobial agent diminished.

References

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External links

• Colloidal Silver information from the National Center for Complementary and Alternative Medicine
• "Integrative Medicine: Colloidal Silver". Memorial Sloan-Kettering Cancer Center.

• Silver
• Dietary supplements
• Nanomaterials
• Alternative medicine