From the Guidelines
For most chronic wounds and burns without infection, Medihoney is generally not recommended due to the lack of strong evidence supporting its use, whereas Silvadene (silver sulfadiazine) is not recommended for routine use in wound healing due to potential delays in healing and risk of antibiotic resistance 1. When considering the use of Medihoney or Silvadene, it's essential to weigh their potential benefits against their drawbacks. Medihoney, a honey-based dressing, has been used for its antimicrobial properties and ability to promote a moist healing environment. However, the evidence supporting its use is limited, and a Cochrane review concluded that the effects of honey relative to its comparators on healing were unclear 1. On the other hand, Silvadene, a topical antibiotic cream, is designed for preventing and treating infections in second and third-degree burns. While it can be effective against many bacteria, its use is associated with potential risks, including skin discoloration, delayed wound healing, and antibiotic resistance 1. Given the lack of strong evidence supporting the use of Medihoney and the potential risks associated with Silvadene, the current recommendation is to avoid using topical antiseptic or antimicrobial dressings, including Medihoney and Silvadene, for wound healing of diabetes-related foot ulcers 1. Instead, dressings should be selected based on exudate control, comfort, and cost, and the use of sucrose-octasulfate-impregnated dressings may be considered as an adjunctive treatment in non-infected, neuro-ischaemic diabetic foot ulcers that are difficult to heal 1. Some key points to consider when choosing a dressing include:
- Exudate control: The dressing should be able to manage the amount of fluid produced by the wound.
- Comfort: The dressing should be comfortable for the patient and not cause any irritation or discomfort.
- Cost: The cost of the dressing should be considered, especially for patients who may require long-term treatment.
- Potential risks: The potential risks associated with the dressing, such as antibiotic resistance or delayed healing, should be carefully considered. Ultimately, the choice of dressing should be individualized based on the patient's specific needs and the characteristics of the wound. The most recent and highest-quality study recommends avoiding the use of Medihoney and Silvadene for routine wound healing, and instead selecting dressings based on exudate control, comfort, and cost 1.
From the Research
Comparison of Medihoney and Silvadene
- Medihoney is a honey-based dressing, while Silvadene is a silver sulfadiazine-based dressing.
- A study comparing the antibacterial and healing properties of medical-grade honey and silver-based wound care products in burns found that silver-based dressings, such as Silvadene, reduced P. aeruginosa numbers below detection levels 2.
- The same study found that Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation, while Silvadene (silver sulphadiazine) slightly inhibited re-epithelialization 2.
- Another study compared the effects of silver sulfadiazine, chlorhexidine acetate, and citric acid on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model, and found that 1% silver sulfadiazine was the most effective treatment 3.
- The effectiveness of silver sulfadiazine against P. aeruginosa biofilms has also been demonstrated, with a concentration of 5-10 mug/mL silver sulfadiazine eradicating the biofilm 4.
- A review of the literature on silver sulfadiazine found that it is an effective agent with low toxicity and few side effects, and can be used in a variety of conditions, including burns 5.
- A study comparing the antibacterial effect of silver-coated dressing, chlorhexidine acetate, and silver sulfadiazine on experimental burn wounds in rats found that silver sulfadiazine significantly eliminated P. aeruginosa more effectively in the tissues than did the other two agents 6.