Editing Medical uses of silver (section)

==Medical uses==

===Antibacterial cream===
{{see also|Silver sulfadiazine}}

Silver sulfadiazine (SSD) is a [[topical antibiotic]] used in partial thickness and full thickness [[burn]]s to prevent infection.<ref name="Medici et al 2016" /><ref name=Ros2013>{{cite book| vauthors = Marx J, Walls R, Hockberger R |title=Rosen's Emergency Medicine - Concepts and Clinical Practice|date=2013|publisher=Elsevier Health Sciences|isbn=978-1455749874|page=814|url=https://books.google.com/books?id=uggC0i_jXAsC&pg=PA814|language=en|url-status=live|archive-url=https://web.archive.org/web/20160913112905/https://books.google.ca/books?id=uggC0i_jXAsC&pg=PA814|archive-date=2016-09-13}}</ref> It was discovered in the 1960s,<ref>{{cite book| vauthors = Coran AG, Caldamone A, Adzick NS, Krummel TM, Laberge JM, Shamberger R |title=Pediatric Surgery|date=2012|publisher=Elsevier Health Sciences|isbn=978-0323091619|page=369|edition=7|url=https://books.google.com/books?id=QpabASTwF_sC&pg=PA369|language=en|url-status=live|archive-url=https://web.archive.org/web/20160913123107/https://books.google.ca/books?id=QpabASTwF_sC&pg=PA369|archive-date=2016-09-13}}</ref> and was the standard topical antimicrobial for burn wounds for decades.<ref><!--This is before Pulsus journals were acquired by OMICS, meaning this not a predatory source -->{{cite journal | vauthors = Adhya A, Bain J, Ray O, Hazra A, Adhikari S, Dutta G, Ray S, Majumdar BK | display-authors = 6 | title = Healing of burn wounds by topical treatment: A randomized controlled comparison between silver sulfadiazine and nano-crystalline silver | journal = Journal of Basic and Clinical Pharmacy | volume = 6 | issue = 1 | pages = 29–34 | date = December 2014 | pmid = 25538469 | pmc = 4268627 | doi = 10.4103/0976-0105.145776 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gomes MT, Campos GR, Piccolo N, França CM, Guedes GH, Lopes F, Belotto RA, Pavani C, Lima RD, Silva DF | display-authors = 6 | title = Experimental burns: Comparison between silver sulfadiazine and photobiomodulation | journal = Revista da Associação Médica Brasileira | volume = 63 | issue = 1 | pages = 29–34 | date = January 2017 | pmid = 28225874 | doi = 10.1590/1806-9282.63.01.29 | doi-access = free }}</ref>

However systemic reviews in 2014, 2017 and 2018 concluded that more modern treatments, both with and without silver, show better results for wound healing and infection-prevention than silver sulfadiazine,<ref name=pmid24899251>{{cite journal | vauthors = Rashaan ZM, Krijnen P, Klamer RR, Schipper IB, Dekkers OM, Breederveld RS | title = Nonsilver treatment vs. silver sulfadiazine in treatment of partial-thickness burn wounds in children: a systematic review and meta-analysis | journal = Wound Repair and Regeneration | volume = 22 | issue = 4 | pages = 473–482 | year = 2014 | pmid = 24899251 | doi = 10.1111/wrr.12196 | s2cid = 19224002 }}</ref><ref name=pmid28161149>{{cite journal | vauthors = Nherera LM, Trueman P, Roberts CD, Berg L | title = A systematic review and meta-analysis of clinical outcomes associated with nanocrystalline silver use compared to alternative silver delivery systems in the management of superficial and deep partial thickness burns | journal = Burns | volume = 43 | issue = 5 | pages = 939–948 | date = August 2017 | pmid = 28161149 | doi = 10.1016/j.burns.2017.01.004 }}</ref><ref name=pmid29903603>{{cite journal | vauthors = Nímia HH, Carvalho VF, Isaac C, Souza FÁ, Gemperli R, Paggiaro AO | title = Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis | journal = Burns | volume = 45 | issue = 2 | pages = 282–292 | date = March 2019 | pmid = 29903603 | doi = 10.1016/j.burns.2018.05.014 | hdl-access = free | hdl = 11449/171102 | s2cid = 49215672 }}</ref> and therefore SSD is no longer generally recommended.<ref name=Was2013>{{cite journal | vauthors = Wasiak J, Cleland H, Campbell F, Spinks A | title = Dressings for superficial and partial thickness burns | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 3 | pages = CD002106 | date = March 2013 | pmid = 23543513 | pmc = 7065523 | doi = 10.1002/14651858.CD002106.pub4 | quote = It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care. }}</ref><ref name=Hey2016>{{cite journal | vauthors = Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S | title = The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review | journal = Burns | volume = 42 | issue = 7 | pages = 1377–1386 | date = November 2016 | pmid = 27126813 | doi = 10.1016/j.burns.2016.03.029 | hdl-access = free | hdl = 1854/LU-8507323 }}</ref>

It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | publisher = [[World Health Organization]] | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free | last1 = Organization | first1 = World Health }}</ref> The US [[Food and Drug Administration]] (FDA) approved a number of topical preparations of silver sulfadiazine for treatment of second-degree and third-degree burns.<ref>{{cite web|url=http://www.accessdata.fda.gov/Scripts/cder/DrugsatFDA/index.cfm?fuseaction=Search.DrugDetails|title=Drugs@FDA|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=2010-07-10|archive-url=https://web.archive.org/web/20140813131107/http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails|archive-date=2014-08-13|url-status=dead}}</ref>

===Dressings===
Despite its widespread use, there is only mixed evidence that silver in dressings has any benefit.<ref name=upd>{{cite journal |vauthors=May A, Kopecki Z, Carney B, Cowin A |title=Antimicrobial silver dressings: a review of emerging issues for modern wound care |journal=ANZ J Surg |volume=92 |issue=3 |pages=379–384 |date=March 2022 |pmid=34806300 |doi=10.1111/ans.17382 |s2cid=244477692 |type=Review}}</ref> A 2018 [[Cochrane (organisation)|Cochrane]] review found that silver-containing dressings may increase the probability of healing for venous leg ulcers.<ref name=pmid29906322>{{cite journal | vauthors = Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC | title = Dressings and topical agents for treating venous leg ulcers | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD012583 | date = June 2018 | issue = 6 | pmid = 29906322 | pmc = 6513558 | doi = 10.1002/14651858.CD012583.pub2 }}</ref>

A number of wound dressings containing silver as an anti-bacterial have been cleared by the U.S. [[Food and Drug Administration]] (FDA).<ref>Ethicon, Inc. [http://www.accessdata.fda.gov/cdrh_docs/pdf2/K022483.pdf "510(k) Summary for K022483"]. Food and Drug Administration (February 3, 2003).</ref><ref>[http://www.accessdata.fda.gov/cdrh_docs/pdf2/K023609.pdf 510(k) "Summary for K023609]". Argentum Medical LLC (January 17, 2003).</ref><ref>[http://www.accessdata.fda.gov/cdrh_docs/pdf5/K050032.pdf 510(k) "Summary for K050032"] Euromed (May 17, 2005).</ref><ref>[http://www.accessdata.fda.gov/cdrh_docs/pdf5/K053627.pdf "510(k) Summary for K053627"]. Kinetic Concepts (February 6, 2006).</ref> However, silver-containing dressings may cause staining, and in some cases tingling sensations as well.<ref>{{Cite web|title=Silver Antimicrobial Dressings in Wound Management: A Comparison of Antibacterial, Physical, and Chemical Characteristics|url=https://www.woundsresearch.com/article/4543|access-date=2021-02-18|website=Wounds Research|language=en}}</ref>

===Endotracheal tubes===
A 2015 systematic review concluded that the limited evidence available indicates that using silver-coated [[endotracheal tube|endotracheal breathing tubes]] reduces the risk of contracting [[ventilator-associated pneumonia]] (VAP), especially during the initial days of utilisation.<ref>{{cite journal | vauthors = Tokmaji G, Vermeulen H, Müller MC, Kwakman PH, Schultz MJ, Zaat SA | title = Silver-coated endotracheal tubes for prevention of ventilator-associated pneumonia in critically ill patients | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD009201 | date = August 2015 | volume = 2015 | pmid = 26266942 | doi = 10.1002/14651858.CD009201 | pmc = 6517140 | veditors = Tokmaji G }}</ref> A 2014 study concluded that using silver-coated endotracheal tubes will help to prevent VAP and that this may save on hospital costs.<ref>{{cite journal | vauthors = Shorr AF, Zilberberg MD, Kollef M | title = Cost-effectiveness analysis of a silver-coated endotracheal tube to reduce the incidence of ventilator-associated pneumonia | journal = Infection Control and Hospital Epidemiology | volume = 30 | issue = 8 | pages = 759–763 | date = August 2009 | pmid = 19538095 | doi = 10.1086/599005 | s2cid = 14809364 | url = https://digitalcommons.wustl.edu/open_access_pubs/820 }}</ref> A 2012 systematic review of randomized controlled trials concluded that the limited evidence available indicates that using silver-coated endotracheal tubes will reduce the incidence of ventilator-associated pneumonia, microbiologic burden, and device-related adverse events among adult patients.<ref>{{cite journal | vauthors = Li X, Yuan Q, Wang L, Du L, Deng L | title = Silver-coated endotracheal tube versus non-coated endotracheal tube for preventing ventilator-associated pneumonia among adults: a systematic review of randomized controlled trials | journal = Journal of Evidence-Based Medicine | volume = 5 | issue = 1 | pages = 25–30 | date = February 2012 | pmid = 23528117 | doi = 10.1111/j.1756-5391.2012.01165.x | s2cid = 23720955 }}</ref> Another 2012 review agreed that the use of silver-coated endotracheal tubes reduces the prevalence of VAP in intubated patients, but cautioned that this on its own is not sufficient to prevent infection. They also suggested that more research is needed to establish the cost-effectiveness of the treatment.<ref name=pmid23035371>{{cite journal | vauthors = Kane T, Claman F | title = Silver tube coatings in pneumonia prevention | journal = Nursing Times | volume = 108 | issue = 36 | pages = 21–23 | year = 2012 | pmid = 23035371 }}</ref> Another 2012 study agreed that there is evidence that endotracheal tubes coated with silver may reduce the incidence of [[ventilator associated pneumonia]] (VAP) and delay its onset, but concluded that no benefit was seen in the duration of intubation, the duration of stay in intensive care or the mortality rate. They also raised concerns surrounding the [[unblinded trial|unblinded]] nature of some of the studies then available.<ref name="pmid22744316"/>

The U.S. Food and Drug Administration in 2007 cleared an endotracheal tube with a fine coat of silver to reduce the risk of ventilator-associated [[pneumonia]].<ref name=FDASilver2007>{{cite web|url= https://www.fda.gov/bbs/topics/NEWS/2007/NEW01741.html| title= FDA Clears Silver-Coated Breathing Tube For Marketing| publisher = [[Food and Drug Administration]]|date= 2007-11-08|archive-url=https://web.archive.org/web/20071114040503/https://www.fda.gov/bbs/topics/NEWS/2007/NEW01741.html|archive-date=November 14, 2007}}</ref>

===Catheters===
A 2014 systemic review concluded that using silver alloy-coated catheters showed no significant difference in incidences of symptomatic Catheter-Associated Urinary Tract Infections (CAUTI) versus using standard catheters, although silver-alloy catheters seemed to cause less discomfort to patients.<ref name=pmid25248140>{{cite journal | vauthors = Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S | title = Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD004013 | date = September 2014 | pmid = 25248140 | doi = 10.1002/14651858.CD004013.pub4 | pmc = 11197149 }}</ref> These catheters are associated with greater cost than other catheters.<ref name=pmid25248140/> A 2014 Multicenter Cohort Study found that using a silver-alloy hydrogel urinary catheter did reduce symptomatic Catheter-Associated Urinary Tract Infection (CAUTI) occurrences as defined by both NHSN and clinical criteria.<ref name="ReferenceA"/> A 2011 critical analysis of eight studies found a consistent pattern which supported using silver-alloy urinary catheters over uncoated catheters to reduce infections in adult patients, and concluded that using silver-alloy catheters would significantly improve patient care.<ref name="ReferenceB"/> A 2007 systemic review concluded that using silver-alloy indwelling catheters for short-term catheterizing will reduce the risk of catheter-acquired urinary tract infection, but called for further studies to evaluate the economic benefits of using the expensive silver alloy-catheters.<ref name="ReferenceC"/> Two systemic reviews in 2004 found that using silver-alloy catheters reduced asymptomatic and symptomatic bacteriuria more than standard catheters, for patients who were catheterised for a short time.<ref>{{cite journal | vauthors = Rosier PK | title = Review: silver alloy catheters are more effective than standard catheters for reducing bacteriuria in adults in hospital having short term catheterisation | journal = Evidence-Based Nursing | volume = 7 | issue = 3 | pages = 85 | date = July 2004 | pmid = 15252913 | doi = 10.1136/ebn.7.3.85 | s2cid = 35670327 | url = http://ebn.bmj.com/cgi/content/short/7/3/85 | doi-access = free }}</ref> A 2000 randomized crossover study found that using the more expensive silver-coated catheter may result in cost savings by preventing nosocomial UTI infections,<ref>{{cite journal | vauthors = Karchmer TB, Giannetta ET, Muto CA, Strain BA, Farr BM | title = A randomized crossover study of silver-coated urinary catheters in hospitalized patients | journal = Archives of Internal Medicine | volume = 160 | issue = 21 | pages = 3294–3298 | date = November 2000 | pmid = 11088092 | doi = 10.1001/archinte.160.21.3294 | doi-access = free }}</ref> and another 2000 study found that using silver alloy catheters for short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia compared with standard catheters, and may thus yield cost savings.<ref>{{cite journal | vauthors = Saint S, Veenstra DL, Sullivan SD, Chenoweth C, Fendrick AM | title = The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection | journal = Archives of Internal Medicine | volume = 160 | issue = 17 | pages = 2670–2675 | date = September 2000 | pmid = 10999983 | doi = 10.1001/archinte.160.17.2670 | doi-access = free }}</ref>

A 2017 study found that a combination of [[chlorhexidine]] and silver-sulfadiazine (CSS) used to coat [[central venous catheters]] (CVC) reduces the rate of catheter-related bloodstream infections.<ref name=pmid28534703>{{cite journal | vauthors = Choi YJ, Lim JK, Park JJ, Huh H, Kim DJ, Gong CH, Yoon SZ | title = Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection: Simulation-based laboratory research with clinical validation | journal = The Journal of International Medical Research | volume = 45 | issue = 3 | pages = 1042–1053 | date = June 2017 | pmid = 28534703 | pmc = 5536400 | doi = 10.1177/0300060517708944 }}</ref> However, they also found that the efficacy of the CSS-CVC coating was progressively eroded by blood-flow, and that the antibacterial function was lost after 48 hours.

===Conjugations with existing drugs===
Research in 2018 into the treatment of central nervous system infections caused by free-living amoebae such as ''Naegleria fowleri'' and ''Acanthamoeba castellanii'', tested the effectiveness of existing drugs as well as the effectiveness of the same drugs when they were conjugated with silver [[nanoparticle]]s. In vitro tests demonstrated more potent amoebicidal effects for the drugs when conjugated with silver nanoparticles as compared to the same drugs when used alone. They also found that conjugating the drugs with silver nanoparticles enhanced their anti-[[Acanthamoebidae|acanthamoebic]] activity.<ref>{{cite journal | vauthors = Anwar A, Rajendran K, Siddiqui R, Raza Shah M, Khan NA | title = Clinically Approved Drugs against CNS Diseases as Potential Therapeutic Agents To Target Brain-Eating Amoebae | journal = ACS Chemical Neuroscience | volume = 10 | issue = 1 | pages = 658–666 | date = January 2019 | pmid = 30346711 | doi = 10.1021/acschemneuro.8b00484 | s2cid = 53037286 }}</ref>

===X-ray film===
Silver-halide imaging plates used with [[X-ray]] imaging were the standard before digital techniques arrived; these function essentially the same as other silver-halide photographic films, although for x-ray use the developing process is very simple and takes only a few minutes. Silver x-ray film remains popular for its accuracy, and cost effectiveness, particularly in developing countries, where digital X-ray technology is usually not available.<ref name=pmid24086301>{{cite journal | vauthors = Zennaro F, Oliveira Gomes JA, Casalino A, Lonardi M, Starc M, Paoletti P, Gobbo D, Giusto C, Not T, Lazzerini M | display-authors = 6 | title = Digital radiology to improve the quality of care in countries with limited resources: a feasibility study from Angola | journal = PLOS ONE | volume = 8 | issue = 9 | pages = e73939 | year = 2013 | pmid = 24086301 | pmc = 3783475 | doi = 10.1371/journal.pone.0073939 | bibcode = 2013PLoSO...873939Z | doi-access = free }}</ref>

===Other uses===
Silver compounds have been used in external preparations as antiseptics, including both [[silver nitrate]] and [[silver proteinate]]. Before the development of antibiotics, [[Credé's prophylaxis]] used a 2% solution of silver nitrate to prevent [[neonatal conjunctivitis]], which used to account for half of all cases of blindness in Europe. <ref name=Schmidt2007>{{Citation |last=Schmidt |first=Axel |title=Gonorrheal ophthalmia neonatorum: Historic impact of Credé's eye prophylaxis |date=2007 |url=https://doi.org/10.1007/978-3-7643-8099-1_4 |work=Pediatric Infectious Diseases Revisited |pages=95–115 |editor-last=Schroten |editor-first=Horst |access-date=2023-11-04 |series=Birkhäuser Advances in Infectious Diseases |place=Basel |publisher=Birkhäuser |language=en |doi=10.1007/978-3-7643-8099-1_4 |isbn=978-3-7643-8099-1 |editor2-last=Wirth |editor2-first=Stefan}}</ref><ref name=Schaller2001>{{cite journal |last1=Schaller |first1=U. C. |last2=Klauss |first2=V. |title=Is Credé's prophylaxis for ophthalmia neonatorum still valid? |journal=Bulletin of the World Health Organization |date=2001 |volume=79 |issue=3 |pages=262–263 |pmid=11285676 |pmc=2566367 |hdl=10665/74722 |hdl-access=free }}</ref> The original procedure called for a 2% silver nitrate solution administered immediately after birth, as Credé erroneously believed that a 1% solution was ineffective due to a previous study by Hecker; however, this was eventually corrected and reduced back down to a 1% solution to reduce chemical irritation to the newborn's eyes.<ref name=Schaller2001/>
Silver nitrate is also sometimes used in dermatology in solid stick form as a [[cauterization|caustic]] ("lunar caustic") to treat certain skin conditions, such as corns and warts.<ref name=NCCIHsilver>{{cite web|title=Colloidal Silver|url=https://nccih.nih.gov/health/silver|publisher=National Center for Complementary and Integrative Health|access-date=9 October 2016|date=July 2009}}</ref>

Silver nitrate is also used in certain laboratory procedures to stain cells. As it turns them permanently a dark-purple/black color, in doing so increasing individual cells' visibility under a microscope and allowing for differentiation between cells, or identification of irregularities. 
Silver is also used in bone prostheses and cardiac devices.<ref name=pmid16766878/> In reconstructive hip and knee surgery, silver-coated titanium prostheses are indicated in cases of recalcitrant prosthetic joint infections.<ref name=pmid34121171>{{cite journal |vauthors=Kontakis MG, Diez-Escudero A, Hariri H, Andersson B, Järhult JD, Hailer NP | title = Antimicrobial and osteoconductive properties of two different types of titanium silver coating | journal = European Cells & Materials | volume = 41 | pages = 694–706 | date = June 2021 | pmid = 34121171 | doi = 10.22203/eCM.v041a45 | s2cid = 235423883 | doi-access = free }}</ref> [[Silver diammine fluoride]] appears to be an effective intervention to reduce dental caries (tooth decay).<ref name=pmid19278981>{{cite journal | vauthors = Rosenblatt A, Stamford TC, Niederman R | title = Silver diamine fluoride: a caries 'silver-fluoride bullet' | journal = Journal of Dental Research | volume = 88 | issue = 2 | pages = 116–125 | date = February 2009 | pmid = 19278981 | doi = 10.1177/0022034508329406 | s2cid = 30730306 }}</ref><ref name=pmid19820733>{{cite journal | vauthors = Deery C | title = Silver lining for caries cloud? | journal = Evidence-Based Dentistry | volume = 10 | issue = 3 | pages = 68 | year = 2009 | pmid = 19820733 | doi = 10.1038/sj.ebd.6400661 | doi-access = free }}</ref> Silver is also a component in dental [[amalgam (dentistry)|amalgam]].

[[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.<ref name=pmid22972041>{{cite journal | vauthors = Lancaster T, Stead LF | title = Silver acetate for smoking cessation | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD000191 | date = September 2012 | volume = 2012 | pmid = 22972041 | pmc = 7043308 | doi = 10.1002/14651858.CD000191.pub2 }}</ref> Silver has also been used in cosmetics, intended to enhance antimicrobial effects and the preservation of ingredients.<ref name=pmid20060498>{{cite journal | vauthors = Kokura S, Handa O, Takagi T, Ishikawa T, Naito Y, Yoshikawa T | title = Silver nanoparticles as a safe preservative for use in cosmetics | journal = Nanomedicine | volume = 6 | issue = 4 | pages = 570–574 | date = August 2010 | pmid = 20060498 | doi = 10.1016/j.nano.2009.12.002 }}</ref>