Table 1.

Published evidence giving recommendations on the use of antimicrobial dressings for treatment of complex wounds

Code	Published guidance	Month	Year	Evidence for use of antimicrobial dressings	Recommendation or conclusions
A	Clinical Practice Guidelines: The nursing management of patients with venous leg ulcers19	First published 1998, updated 2005 and 2006		The evidence in the guidance for ‘Antimicrobial agents versus placebo or standard care’ is based on a systematic review by O'Meara published in 2000 reviewing 14 RCTs. The RCTs were small and of poor quality, therefore no firm conclusions could be drawn.	Dressings must be simple, low adherent and acceptable to the patient. Cost-effectiveness of leg ulcer dressings should be determined by their ability to stay in place for up to a week
B	Cochrane review: Topical silver for treating wound infection39	January	2007	This assessed topical silver products (creams or dressings) for the prevention of wound infection through the evaluation of 26 RCTs. The majority of studies found no statistical difference in infection rates between silver and non-silver dressings. Most of the trials were small and of poor quality.	There is insufficient evidence to support the use of silver dressings as they did not reduce infection or promote wound healing
C	Cochrane review: Honey as a topical treatment for wounds40	First published 2008, updated 2015		26 trials were identified. Two of high quality found that honey dressings heal partial thickness burns more quickly than conventional dressings. Other trials either showed no difference between treatments or were based on low-quality evidence	The evidence for the effect of honey compared with other dressings is low quality, and therefore not robust enough basis for decision making
D	SIGN guidance: Management of venous leg ulcers16	August	2010	The recommendations for silver dressings are based on a Cochrane review in 2007 by Vermeulen et al and the VULCAN trial in 2009. These found insufficient evidence to show improved healing rates for wounds treated with silver dressings compared with other types of dressings	Guidance concludes that simple non-adherent dressings are recommended for VLU* management. Silver dressings are not
E	NICE guidance: Pressure ulcers: prevention and management41	April	2014	Alginate versus silver alginate. No statistical difference, very low-quality evidence	The evidence did not allow for a recommendation of any specific type of dressing. Recommends a dressing that promotes an optimal healing environment rather than a specific type
F	NICE guidance: Diabetic foot problems: prevention and management42	August	2015	Included one RCT comparing iodine-impregnated dressings with others; found no difference in healing rates	Take into account clinical assessment of the wound and patient preference. Use dressing of lowest acquisition cost appropriate
G	Chronic wounds: Advanced wound dressings and antimicrobial dressings11	March	2016	Gives an overview of previously published evidence and summarises research findings	There is little good-quality evidence to support the use of antimicrobial dressings. Healthcare professionals should choose the least costly option, which will provide the optimal environment for the type of wound and stage of healing

*Venous leg ulcers

NICE, The National Institute for Health and Care Excellence; RCT, randomised controlled trial; SIGN, Scottish Intercollegiate Guidelines Network; VLU, Venous leg ulcers.