# The efficacy of three antimicrobial dressings in the management of diabetic foot ulcers: a systematic review and network meta-analysis

## TL;DR

This study compares three antimicrobial dressings for diabetic foot ulcers and finds antibiotic-impregnated bone cement and silver dressings to be most effective.

## Contribution

The study provides the first network meta-analysis comparing silver, honey, and antibiotic-impregnated bone cement dressings for diabetic foot ulcers.

## Key findings

- Antibiotic-impregnated bone cement (ABC) showed superior healing rates and reduced healing time compared to standard care.
- Silver dressings outperformed standard care in healing rates and wound area reduction.
- ABC and silver dressings ranked highest in SUCRA analysis for DFU management.

## Abstract

Antimicrobial dressings have been used to treat diabetic foot ulcers (DFU). However, no direct or indirect comparison among silver dressings, honey dressings or antibiotic-impregnated bone cement (ABC) for DFU has been performed to date.

To systematically evaluate the efficacy of the three antimicrobial dressings in the management of DFU.

A comprehensive search of PubMed, Embase, The Cochrane Library, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing silver dressings, honey dressings, and ABC in the treatment of DFU, from database inception to November 2025. Two investigators in-dependently performed study selection, data extraction, and assessment of risk of bias. Data analyses were conducted using Stata 18.0.

A total of 15 RCTs encompassing 1,292 patients were included. The network meta-analysis revealed that ABC demonstrated superiority over standard care in both healing rate and healing time (OR = 4.06, 95% CI [1.48, 11.1], P < 0.05; SMD = –2.25, 95% CI [–4.11, –0.40], P < 0.05). Silver dressings also outperformed standard care in terms of healing rate and wound area reduction (OR = 2.31, 95% CI [1.14, 4.69], P < 0.05; SMD = 1.43, 95% CI [0.39, 2.47], P < 0.05). Based on the surface under the cumulative ranking curve, ABC and silver dressings ranked as the most favorable therapeutic options.

According to the network meta-analysis and SUCRA ranking results, an-tibiotic bone cement and silver dressings appear to be the most advantageous strategies for DFU management. Future studies should include direct comparisons among various antimicrobial dressings and incorporate cost-effectiveness analyses to guide optimal clinical decision-making.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024578370, identifier CRD42024578370.