Efficacy and Safety of Silver Sulfadiazine Dressings and Nanocrystalline Silver Dressings on Burns: A Systematic Review and Meta‐Analysis

ABSTRACT

Aim

Nanocrystalline silver dressings are increasingly used as alternatives to silver sulfadiazine dressings in burn management, but comparative evidence remains inconclusive. This meta-analysis aimed to compare the efficacy and safety of nanocrystalline silver dressings versus silver sulfadiazine dressings in burn patients.

Design

Systematic review and meta-analysis following PRISMA guidelines. The review was registered with PROSPERO (CRD420251060978).

Data Sources

PubMed, Embase, Cochrane Library and Web of Science were searched from inception through April 2025.

Methods

Randomized controlled trials comparing nanocrystalline silver dressings with silver sulfadiazine dressings in burn patients were included. Primary outcomes were wound healing time and adverse events. Secondary outcomes included complete re-epithelialization rates and dressing change frequency. Risk of bias was assessed using the Cochrane risk of bias tool. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations framework. Meta-analysis was performed using Review Manager 5.4.

Results

Eight randomized controlled trials (724 patients) were included. Nanocrystalline silver dressings significantly reduced wound healing time (mean difference [MD] = −3.29 days, 95% confidence interval [CI]: −3.82 to −2.76; p < 0.00001; I ² = 0%) and dressing change frequency (MD = −8.76, 95% CI: −12.68 to −4.85; p < 0.00001; I ² = 94%). No significant differences were found in re-epithelialization rates (odds ratio = 1.08, p = 0.80) or adverse events (risk difference = −0.00, p = 0.99). Evidence certainty was low to very low across all outcomes.

Conclusions

Nanocrystalline silver dressings may offer advantages over silver sulfadiazine dressings in reducing wound healing time and dressing change frequency in burn patients, but the overall certainty of evidence is low to very low. Future well-powered, multicenter trials with standardized outcomes and extended follow-up are needed.

Relevance to Clinical Practice

These findings support the consideration of nanocrystalline silver dressings for burn wound management, particularly for reducing wound healing time and nursing workload associated with dressing changes. However, dressing selection should be guided by burn depth, infection risk, patient-specific factors, and resource availability.

Reporting Method

We have adhered to relevant EQUATOR guidelines, particularly the PRISMA checklist.

Patient or Public Contribution

No patient or public contribution.

Systematic Review Registration

PROSPERO CRD420251060978.