Silver has a long and intriguing history as an antibiotic in human health care. It has been
developed for use in water purification, wound care, bone prostheses, reconstructive orthopaedic
surgery, cardiac devices, catheters and surgical appliances. Advancing biotechnology
has enabled incorporation of ionizable silver into fabrics for clinical use to reduce the risk of
nosocomial infections and for personal hygiene. The antimicrobial action of silver or silver
compounds is proportional to the bioactive silver ion (Ag+
) released and its availability to interact
with bacterial or fungal cell membranes. Silver metal and inorganic silver compounds ionize
in the presence of water, body fluids or tissue exudates. The silver ion is biologically active
and readily interacts with proteins, amino acid residues, free anions and receptors on mammalian
and eukaryotic cell membranes. Bacterial (and probably fungal) sensitivity to silver is
genetically determined and relates to the levels of intracellular silver uptake and its ability to
interact and irreversibly denature key enzyme systems. Silver exhibits low toxicity in the
human body, and minimal risk is expected due to clinical exposure by inhalation, ingestion,
dermal application or through the urological or haematogenous route. Chronic ingestion or
inhalation of silver preparations (especially colloidal silver) can lead to deposition of silver
metal/silver sulphide particles in the skin (argyria), eye (argyrosis) and other organs. These are
not life-threatening conditions but cosmetically undesirable. Silver is absorbed into the human
body and enters the systemic circulation as a protein complex to be eliminated by the liver and
kidneys. Silver metabolism is modulated by induction and binding to metallothioneins. This
complex mitigates the cellular toxicity of silver and contributes to tissue repair. Silver allergy is
a known contra-indication for using silver in medical devices or antibiotic textiles.
Copyright / Drug Dosage
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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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