Current Development of Silver Nanoparticle Preparation, Investigation, and Application in the Field of Medicine

Table 1

Commonly used burn topical antimicrobials.

Agent	Advantages	Disadvantages
0.5% silver nitrate solution; Introduced in 1964	(i) Bactericidal against most gram positive, gram negatives, and yeast; (ii) Avoids mucopurulent exudate formation (pseudoeschar); (iii) Minimal pain after application; (iv) No hypersensitivity	(i) No eschar penetration; (ii) Electrolyte imbalance (hypotonic solution depletes wounds cations); (iii) Needs frequent application; (iv) Discolors wound bed; (v) Possible methemoglobinemia; (vi) Rare silver toxicity
Mafenide acetate—historically 11.1% in water-soluble cream, but newer formulation is 8.5%; First introduced in 1964	(i) Bacteriostatic against most gram positives, gram negatives; may be more effective for clostridial and pseudomonal infections than silver nitrate or SSD; (ii) Good eschar penetration	(i) Potential loss of bacteriostatic action at high (>10^6) bacterial loads; (ii) Effective concentration in eschar drops below therapeutic levels after 10 hours—needing twice daily application; (iii) Metabolic acidosis [drug and metabolite (p-carboxybenzenesulfonamide) inhibit carbonic anhydrase—can worsen ventilation]; (iv) Pain after application; (v) Potential hypersensitivity
1% silver sulfadiazine (SSD) water-soluble cream; Developed in 1968	(i) Bactericidal against most gram positives and some gram negatives; (ii) Minimal pain after application	(i) Less activity against certain gram negatives (Enterobacter and Pseudomonas) and yeast; (ii) Poor eschar penetration; (iii) Forms pseudoeschar that requires daily washings; (iv) Neutropenia^A; (v) Potential hypersensitivity to sulfa component; (vi) Rare silver toxicity
Mafenide acetate—5% solution; First introduced in 1971	(i) Similar to cream; (ii) Less pain after application versus cream	(i) Similar to cream; (ii) Effective concentration in eschar drops below therapeutic levels after 6–8 hours—needing 3x-4x daily application
Acticoat; Rayon/polyester core encased in dense polyethylene mesh coated with nanocrystalline silver	(i) Bactericidal against most gram positives, gram negatives, and fungus; (ii) Sustained silver release for 3–7 days; (iii) Minimizes pain from daily dressings	(i) Poor eschar penetration; (ii) Requires maintenance of moist dressings for silver release; (iii) Rare silver toxicity

Table information modified and compiled from the following references: [67–71].
^ANeutropenia thought to be due to transient depression of granulocyte-macrophage progenitor cells in the marrow [67].