Silver-based wound dressings: current issues and future developments for treating bacterial infections

The rapid and continuing emergence of antimicrobial resistance is challenging our ability to effectively fight bacterial infections.This challenge is particularly felt in clinical settings where patients experience severely infected chronic wounds.Despite the increased development and reliance on silver-based dressings, the evidence underpinning their clinical efficacy is inconclusive and there remain concerns and confusion about their use.In this review, we describe the rationale for the current use of silver and silver-based wound dressings and highlight the progress and challenges associated with developing more advanced nanoparticle-based dressings for the safe and effective delivery of silver.Specifically, we describe the development of silver nanoparticles (AgNPs) with unique characteristics that render them applicable for controlling bacterial infections while simultaneously promoting wound healing through mechanisms including the dampening of inflammation and promotion of wound re-epithelialisation. Finally, we describe the latest progress in the development of different types of hydrogels for the therapeutic delivery of AgNPs to infected wounds.The possibility of designing and establishing multimodal silver therapies for the safe and effective treatment of infected wounds would be of great benefit for wound care management and improved patient outcomes.