noxythiolin and Peritonitis

The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Clinical Trials as Topic; Drug Resistance; Guinea Pigs; Humans; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Surgical Wound Infection; Tissue Adhesions

The efficacy of Noxythiolin in solution for peritoneal toilet during operation on 48 patients with acute generalized peritonitis was evaluated. The trial was prospective, with random selection of patients who were divided into two groups with identical backgrounds, initial affections, and therapies applied. No significant differences were noted in prognosis, bacteriological findings or subsequent course in the survivors in the two groups. The only favorable effect noted in the group treated with Noxythiolin was the frequency with which further operations had to be performed, but the difference was nos significant. Though the use of peritoneal antiseptics isjustified when positive bacteriological test are reported, the determining element in peritoneal toilet appears to be the volume of liquid employed, independently of its composition.

Topics: Acute Disease; Aged; Clinical Trials as Topic; Female; Humans; Intraoperative Care; Male; Middle Aged; Noxythiolin; Peritoneum; Peritonitis; Postoperative Period; Prognosis; Recurrence; Solutions; Therapeutic Irrigation; Thiourea

The favourable experience of M. BROWN with noxythiolin in fecal peritonitis has prompted us, over the last seven years, to use this product in all forms of generalized peritonitis. This study involved 187 cases of generalized peritonitis : 102 males and 85 females, whose mean age was 53 years. Noxythiolin was reserved for severe cases (after having deliberately decided not to perform a comparative control series), the severity being related to the advanced age of the patients, the delay in intervention, and preexisting disorders. It was used in the form of a peroperative lavage of the peritoneal cavity and a postoperative instillation. The overall survival (71 p. 100) and that observed in particular in peritonitis of colonic origin (58 p. 100), seem to be arguments in favour of the beneficial effect of the product. Noxythiolin contributes to the sterilization of the peritoneal cavity. By virtue of its efficacy, the simplicity of its use, and its innocuousness, it merits a place in the therapeutic arsenal for treatment of generalized peritonitis, in combination with systemic treatments.

Topics: Age Factors; Clinical Trials as Topic; Drug Evaluation; Female; Humans; Male; Middle Aged; Noxythiolin; Paris; Peritoneal Cavity; Peritonitis; Therapeutic Irrigation; Thiourea

The authors present a series of 30 cases of acute supra- and inframesocolic peritonitis which, in addition to the treatment of their organic causes, benefitted from medical treatment by noxythioline, used as a peritoneal lavage, an irrigation with aspiration, or an instillation. A marked amelioration in the postoperative course was noted, particularly in those cases with infra-mesocolic peritonitis, with the absence of adhesions and suppurative collections on reintervention, and a rapid return to negativity of the positive bacteriological investigations performed systematically on the pe ritoneal fluid and on the drainage.

Topics: Acute Disease; Administration, Topical; Adolescent; Adult; Age Factors; Aged; Clinical Trials as Topic; Drug Tolerance; France; Humans; Middle Aged; Noxythiolin; Peritoneal Dialysis; Peritonitis; Therapeutic Irrigation; Thiourea

The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Clinical Trials as Topic; Drug Resistance; Guinea Pigs; Humans; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Surgical Wound Infection; Tissue Adhesions

A controlled trial of intraperitoneal noxytiolin (Noxiflex) solution in patients with peritonitis due to perforated appendicitis is reported. No significant difference was found in the incidence of complications between the treated and a control group, raising doubts as to whether this substance is of value when used intraperitoneally in peritonitis.

Topics: Administration, Topical; Appendectomy; Appendicitis; Clinical Trials as Topic; Female; Humans; Intestinal Perforation; Intestinal Pseudo-Obstruction; Male; Noxythiolin; Peritonitis; Surgical Wound Infection; Thiourea

Topics: Abdomen; Abscess; Humans; Noxythiolin; Peritonitis; Postoperative Complications; Premedication; Surgical Wound Infection; Thiourea

Topics: Humans; Instillation, Drug; Noxythiolin; Peritonitis; Therapeutic Irrigation; Thiourea

A model of bacterial peritonitis, using mice infected with Escherichia coli, has been used to assess the protective effects of intraperitoneal treatment with antiseptics. Of the five antiseptics tested, only chlorhexidine gluconate had any protective effect, concentrations of 0.05 and 0.02 per cent reducing the mortality to 14 and 50 per cent respectively. The other antiseptics, taurolin, noxytiolin, povidone iodine and hypochlorite were all ineffective. Delayed treatment with chlorhexidine was not as effective as instillation immediately postinfection.

Topics: Animals; Anti-Infective Agents, Local; Chlorhexidine; Disease Models, Animal; Escherichia coli Infections; Hypochlorous Acid; Injections, Intraperitoneal; Male; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Taurine; Thiadiazines; Time Factors

Peritoneal infection progresses through defined stages: contamination, inflammation and abscess formation. An experimental model of established peritonitis without adjuvant in the rat was used to test the effect of various local and systemic agents on survival. There was significant improvement in all treatment groups except those treated with antiseptic lavage using PVP-I and noxythiolin. Intramuscular ampicillin improved survival from 40 to 60 per cent while intramuscular amikacin combined with local irrigation with metronidazole reduced mortality to nil (P less than 0.001). Both cephradine and metronidazole used as peritoneal lavage solutions improved survival (P less than 0.005) when compared with the controls but the difference was not significant when compared with irrigation with Hartmann's solution. Metronidazole given rectally also improved survival from 40 to 60 per cent but this difference was not significant. We conclude that survival in established peritonitis depends upon adequate antibiotic therapy.

Topics: Amikacin; Ampicillin; Animals; Cephradine; Disease Models, Animal; Injections, Intramuscular; Isotonic Solutions; Male; Metronidazole; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Rats, Inbred Strains; Rectum; Ringer's Lactate; Therapeutic Irrigation

A controlled mixed peritoneal infection was produced by inoculation of bacteria into the peritoneum and peritonitis was allowed to become established. A laparotomy was performed and peritoneal toilet with a variety of agents was carried out. Local povidone-iodine in the inflamed peritoneum proved to be not only of no benefit but, in fact, to be toxic. In the standard concentrations recommended it proved lethal. Noxythiolin 2.5 per cent also had no beneficial effect. There was a significant difference between the effect of povidone-iodine when instilled into an inflamed peritoneum and instillation into the intact peritoneal cavity. We would advise caution in the use of these antiseptics in any situation in which local defence mechanisms have been compromised as a result of established infection.

Topics: Animals; Bacterial Infections; Disease Models, Animal; Male; Noxythiolin; Peritonitis; Povidone; Povidone-Iodine; Rats; Rats, Inbred Strains; Thiourea

Topics: Adult; Aged; Female; Halitosis; Humans; Male; Middle Aged; Noxythiolin; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Thiourea

Topics: Adult; Aged; Humans; Middle Aged; Noxythiolin; Peritonitis; Therapeutic Irrigation; Thiourea

Topics: Anti-Bacterial Agents; Clindamycin; Gentamicins; Humans; Methods; Noxythiolin; Peritonitis; Postoperative Care; Preoperative Care; Therapeutic Irrigation

Topics: Humans; Noxythiolin; Peritonitis; Postoperative Complications; Suppuration; Thiourea

The intraperitoneal instillation of noxythiolin in the treatment of peritonitis is widespread in clinical practice despite contradictory evidence as to its efficacy. In this light the value of noxythiolin was reappraised by studying its effect in guinea-pigs and mice with induced bacterial peritonitis. Treatment with a 1% solution of noxythiolin reduced the mortality rate of mice by 14% (P less than 0.1). The guinea-pig model proved unreliable giving inconsistent mortality rates throughout. Further studies are required to determine the optimum dose and concentration of noxythiolin while the search for more effective intraperitoneal antiseptics should continue.

Topics: Animals; Escherichia coli Infections; Female; Guinea Pigs; Injections, Intraperitoneal; Mice; Noxythiolin; Peritonitis; Thiourea

Noxythiolin (Noxyflex, Geistlich), given intraperitoneally as a 2.5 per cent solution, protected mice from the lethal effects of an intraperitoneal injection of Escherichia coli. Povidone-iodine (Pevidine, Berk), containing 0.075 per cent iodine, gave no protection.

Topics: Animals; Escherichia coli; Injections, Intraperitoneal; Male; Mice; Noxythiolin; Peritonitis; Povidone; Povidone-Iodine; Thiourea

Peritoneal lavage resulted in a significant reduction in the duration of hospital stay in a retrospective series of 189 children with peritonitis secondary to perforation of the appendix. Antibiotic peritoneal lavage also resulted in a significant reduction in the number of children with septic and adhesive complications compared with antiseptic lavage and no lavage, mainly as a result of fewer wound infections. The overall incidence of residual intraperitoneal infection was low, and although differences in this respect were not significant, none of the children treated with antibiotic peritoneal lavage required reoperation for intraperitoneal sepsis.

Topics: Appendicitis; Child; Humans; Length of Stay; Noxythiolin; Peritonitis; Tetracycline; Therapeutic Irrigation; Thiourea

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Humans; Noxythiolin; Peritonitis; Rats; Sepsis; Surgical Wound Infection; Tetracycline; Therapeutic Irrigation

Topics: Adolescent; Adult; Aged; Drainage; Female; Humans; Male; Middle Aged; Noxythiolin; Peritonitis; Therapeutic Irrigation; Thiourea; Time Factors

Topics: Aged; Female; Humans; Male; Middle Aged; Noxythiolin; Peritonitis; Therapeutic Irrigation; Thiourea

Topics: Humans; Noxythiolin; Peritonitis; Thiourea; Tissue Adhesions

The evidence for the value of noxytiolin (Noxyflex) in peritonitis is contradictory. In a controlled trial of the effect of noxytiolin in pertonitis in rabbits we have found a significant increase in mortality in the trial group compared with a control group, but no significant difference when a dose equivalent to the recommended human dose is used. The postoperative course is adversely affected in the animals receiving noxytiolin.

Topics: Animals; Noxythiolin; Peritonitis; Rabbits; Thiourea