Silver

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Chapter: Pharmaceutical Microbiology : Alternative Strategies For Antimicrobial Therapy

It is perhaps not strictly appropriate to discuss the use of silver as an alternative to antibiotics, because silver functions really as an antiseptic biocide more like chlorhexidine or povidone-iodine.


SILVER   

 

It is perhaps not strictly appropriate to discuss the use of silver as an alternative to antibiotics, because silver functions really as an antiseptic biocide more like chlorhexidine or povidone-iodine. However, some reviews have discussed it in this context and so it is included here for completeness. Silver has of course been used over centuries to treat and prevent infections, and like some of the other forms of treatment described in this chapter, its use decreased with the advent of antibiotics. In the form of silver sulphadiazine, however, it has been a mainstay in the treatment of wound, particularly burn, infections for the last 40 years and this is likely to continue. In addition, the number of wound dressings containing silver as an antimicrobial component is increasing. Despite this, there are a limited number of conclusive clinical trials attesting to their efficacy and this situation certainly needs to be addressed.

 

Silver can generate a number of different ions, i.e. Ago, Ag+, Ag2+ and Ag3+. Elemental silver has no antibacterial activity and the principal active component is the Ag+ cation which forms when in contact with aqueous solutions. This ion has wide-ranging detrimental effects on the bacterial cell by disrupting membrane function and enzyme activity. There is activity against a broad range of bacterial pathogens including the important Staph. aureus and Ps. aeruginosa. Since the silver ion can be quenched by the presence of chloride ions, continued activity relies on the continuous release of further silver ions. Improved activity has been reported for the use of nanocrystalline silver which also appears to have an antiinflammatory action. Despite its widespread use there are limited reports on the toxicity of silver and the incidence of resistance is currently low.

 

The worsening situation with regard to antibiotic resistance has brought all potential therapies into sharper focus and silver is a candidate for increasing use, for example as a coating on medical devices such as urinary catheters and endotracheal tubes to prevent biofilm formation.

 

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