SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Clinical Diabetes
This article is part of the Research TopicFrontiers in Diagnostic and Therapeutic approaches in Diabetic Sensorimotor Neuropathy, Volume IIView all 6 articles
The Efficacy of Three Antimicrobial Dressings in the Management of Diabetic Foot Ulcers: A Systematic Review and Network Meta-analysis
Provisionally accepted
- 1School of Nursing, Mudanjiang Medical University, Mudanjiang, China
- 2Department of General Practice, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
- 3Department of Respiratory Diseases, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
- 4General Surgery Department, Shanxi Bethune Hospital, Taiyuan, China
- 5General Surgery Department, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
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Background: Antimicrobial dressings have been used to treat diabetic foot ulcers (DFU). However, no direct or indirect comparison among silver dressings, honey dressings or antibiotic-loaded bone cement (ABC) for DFU has been performed to date. Objective: To systematically evaluate the efficacy of the three antimicrobial dressings in the management of DFU. Methods: 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. Results: 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. Conclusions: According to the network meta-analysis and SUCRA ranking results, ABC 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.
Keywords: Antibiotic bone cement, Diabetic foot ulcers, Honey dressings, Network meta-analysis, Silver ion dressings
Received: 04 Jan 2026; Accepted: 03 Feb 2026.
Copyright: © 2026 He, Li, Chen, Lu, Zhang, Han and Ning. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoyuan He
Yaoxing Li
Zhenguo Han
Mei Ning
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