The continuing debate on silver in wound management: addressing frequently asked questions, controversies and...

The use of silver has a long history in human civilisation, particularly as an antimicrobial agent in infection control and prevention. Although silver was first used to treat wound infection approximately 2000 years ago, issues such as its safety profile, clinical and cost-effectiveness, potential overuse and risk of bacterial resistance, remain topics of discussion. Therefore, this review re-examines these issues in light of contemporary microbiological and clinical evidence. The silver cation (Ag⁺) is a broad-spectrum topical antiseptic with a well-established safety profile, supported by regulatory evaluations and extensive clinical use. Concerns around bacterial resistance largely stem from laboratory models that do not reflect real wound environments. Known genetic resistance mechanisms exist but are rare in clinically relevant wound pathogens, and have not resulted in stable resistance, with key organisms remaining susceptible to modern silver-containing dressings. Reduced silver activity observed in vitro, particularly in biofilm models, is often a consequence of extracellular polymeric substance-mediated shielding rather than heritable resistance mechanisms. Within the wound hygiene framework, emphasising cleansing and debridement to disrupt biofilm, silver-containing dressings remain an effective tool for managing bioburden and supporting wound progression. Concerns regarding overuse underscore the need for appropriate, indication-driven application rather than reduced access. Overall, evidence shows that silver remains a highly effective option in antimicrobial wound care and that clinically relevant silver resistance is negligible. When used judiciously, silver-containing dressings remain safe and effective, and are an important component in the management of wounds that are infected or at risk of infection. This review aims to critically re-evaluate the role, benefits and limitations of silver-containing dressings in wound management, and to address questions that have recently arisen.