Medical uses of silver: Difference between revisions

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===Anti-smoking aid===
===Anti-smoking aid===
[[Silver acetate]] has been used as a potential aid to help stop smoking. When combined with tobacco smoke, silver acetate produces a bad taste which researchers predicted might reduce the desire to smoke. Early reviews suggested a modest short-term effect, but no long-lasting reduction of smoking.<ref>Hymowitz N, Eckholdt H. Effects of a 2.5-mg silver acetate lozenge on initial and long-term smoking cessation. Prev Med. 1996 Sep-Oct;25(5):537-46</ref> A review of the literature in 2012 suggested no effect of silver acetate on smoking cessation at a six month endpoint.<ref>Lancaster T, Stead LF. Silver acetate for smoking cessation. Cochrane Database Syst Rev. 2012 Sep 12;9:CD000191. doi: 10.1002/14651858.CD000191.pub2</ref>
[[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>{{cite journal|last=Lancaster|first=T|coauthors=Stead, LF|title=Silver acetate for smoking cessation.|journal=Cochrane database of systematic reviews (Online)|date=2012 Sep 12|volume=9|pages=CD000191|pmid=22972041}}</ref>


===Antiseptic use===
===Antiseptic use===

Revision as of 22:19, 16 January 2013

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.[1]

While wound dressings containing silver sulfadiazine or silver nanomaterials may be used to treat external infections,[2][3][4] there is little evidence to support their use.[5] Silver is also used in some medical applications, such as urinary catheters and endotracheal breathing tubes, where the silver content is effective in reducing incidences of catheter-related urinary tract infections and ventilator-associated pneumonia (VAP), respectively.[6][7][8][9] Silver is also used in bone prostheses, reconstructive orthopedic surgery and cardiac devices,[10] as well as on surfaces and fabrics to reduce the spread of infection.[11][12] 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.[13]

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.[14][15] 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.[1][16]

Medical uses

Dressings

A Cochrane review from 2008 did not recommend silver sulfadiazine, an ointment containing silver, for burns as it potentially prolongs healing time.[17] It however used to be deemed the "gold standard" in topical treatment.[2]

There is insufficient evidence to support the use of silver containing dressings.[5] These dressings sometimes result in a slower healing process.[2] The evidence for their use is marred by the poor quality of the trials.[18] Most of the studies have been small and they generally indicated that the treatments did not promote wound healing or prevent wound infections.[19][20]

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.[1][2]The US Food and Drug Administration has approved topical preparations of silver sulfadiazine for treatment of second- and third-degree burns.[21]

Dressings incorporating nanocrystalline silver or activated silver-impregnated substances are available,[2] which deliver higher concentrations of the active silver ion.[11] As of 2006, more "than 10 dressings containing pure silver" were available.[4] 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.[4]

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.”[22] Silver has proven 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.[23]

Catheters and endotracheal tubes

The antibiotic properties of silver are used in some other medical applications, such as catheters and endotracheal breathing tubes.[8][24] A study on the use of silver-alloy catheters by the University of Michigan School of Medicine concluded “The data supporting the use of silver alloy urinary catheters to reduce urinary catheter-related bacteriuria is reasonably strong.”[6] The study also concluded silver alloy catheters are more effective than standard catheters for reducing bacteriuria in adults in hospital having short-term catheterization, and, although they cost about $6 more than standard urinary catheters, they may be worth the extra cost, since catheter-related infection is a common cause of nosocomial infection and bacteremia. Related meta-analysis also clarified discrepant results among earlier trials of silver-coated urinary catheters by revealing silver alloy catheters are significantly more effective in preventing urinary tract infections than are silver oxide catheters.[7] These conclusions are supported by, among others, studies by the University Hospitals Leuven, Belgium[11] and the University Hospital for Anesthesiology and Surgical Intensive Care, Halle, Germany.[25]

Ionizable silver has been incorporated into fabrics to reduce the spread of bacteria.[11]

Ventilator-associated pneumonia (VAP) causes substantial morbidity. A 2008 study by Kollef et al. concluded, “Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube.”[8] In addition, the U.S. Food and Drug Administration (FDA) has recently approved an endotracheal tube with a fine coat of silver for use in mechanical ventilation, after studies found it reduced the risk of ventilator-associated pneumonia.[9]

The use of these devices is contraindicated for persons who are allergic to silver,[11] and although they are widely used in hospitals, no thorough testing and standardization of these products has yet been undertaken.[23]

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.[26]

Antiseptic use

Silver compounds continue to be used in external preparations as antiseptics,[15] 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.[1]

Disinfectant use

Liquid sprays containing silver are effective as a hard-surface disinfectant[27]

Adverse effects

Main article: Argyria

In animals and humans, silver accumulates in the body.[28] 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 asargyria.[11] Localized argyria can occur as a result of topical use of silver-containing solutions, while generalized argyria results from the ingestion of such substances.[29]

Argyria is generally believed to be irreversible, with the only practical method of minimizing its cosmetic disfigurement being to avoid the sun,[30] but laser therapy has been used to treat it with satisfactory cosmetic results.[31][32][33] The Agency for Toxic Substances and Disease Registry (ATSDR) describes argyria as a "cosmetic problem",[34] but medical literature from 1935 and 1940, when argyria occurred more frequently, emphasizes it as a socially debilitating condition.[35][36]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.[29][37]


One death has been reported in the medical literature due to silver toxicity, in which a 71-year-old man developed status epilepticus after repeated oral ingestion of colloidal silver. Researchers concluded that the neurotoxicity and the resulting death were due to ingestion of colloidal silver.[38] [15]


Colloidal silver may interact with some prescription medications, reducing the absorption and effectiveness of tetracyclines, quinolone antibiotics, levothyroxine, andpenicillamine.[15][39]

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.[40] 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.[41] 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).[42][43][44]

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.[11] 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.[11] 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.[45] The antibacterial action of electrodes coated with silver nanostructures is greatly improved in the presence of an electric field.[46]

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,[14] as well as tuberculosis.[1][47][48] No medical evidence supports the ingestion of colloidal silver as being effective for any of these claimed indications,[16][49][1] and some clinical studies in humans demonstrate toxicity.[15] Silver is not an essential mineral in humans; there is no dietary requirement for silver, and no such thing as a silver "deficiency".[1]

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.[30]

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.[16] 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.[16] 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.[50][51] 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."[52] 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.[1]

Environmental effects

Silver that enters the environment from discarded medical sources can have detrimental effects on micro-organisms and animals (including humans).[53]

History

Hippocrates in his writings discussed the use of silver in wound care.[54][55] At the beginning of the twentieth century surgeons routinely used silver sutures to reduce the risk of infection.[56][57] In the early 20th century, physicians used silver-containing eyedrops to treat ophthalmic problems,[58] for various infections,[59][60] and sometimes internally for diseases such as tropical sprue, epilepsy, gonorrhea, and the common cold.[1][15][61] During World War I, soldiers used silver leaf to treat infected wounds.[62][63]

Prior to the introduction of modern antibiotics, colloidal silver was used as a germicide and disinfectant.[64] With the development of modern antibiotics in the 1940s, the use of silver as an antimicrobial agent diminished.[23]

References

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External links

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