povidone-iodine and Acute-Disease

Iodine and its antibacterial properties have been used for the prevention or management of wound infections for over 150 years. However, the use of solutions (tincture) of iodine has been replaced by the widespread use of povidone-iodine, a water-soluble compound, which is a combination of molecular iodine and polyvinylpyrrolidone. The resultant broad spectrum of antimicrobial activity is well documented and its efficacy, particularly in relation to resistant micro-organisms such as methicillin-resistant Staphylococcus aureus, has been shown. In the clinical environment, there is no general agreement regarding the 'best' antiseptic and the practice varies widely. This article reviews the studies that have assessed the efficacy of povidone-iodine in hand disinfection and skin preparation and its use as an antiseptic irrigant. Although there is a distinct lack of well-designed, randomised controlled trials evaluating antiseptic efficacy, selection should be based on the next best available evidence. This evidence suggests that the use of povidone-iodine as an agent of choice is dependent on the clinical need but is also likely to be influenced by personal preference.

Topics: Acute Disease; Anti-Infective Agents, Local; Antisepsis; Choice Behavior; Enema; Evidence-Based Medicine; Hand Disinfection; Humans; Microbial Sensitivity Tests; Patient Selection; Peritoneal Lavage; Povidone-Iodine; Preoperative Care; Randomized Controlled Trials as Topic; Research Design; Skin Care; Therapeutic Irrigation; Treatment Outcome; Urinary Catheterization; Wound Infection

Wound cleansing is an integral part of the management of acute traumatic wounds. There is consensus that it reduces infection rates. However, the choice of cleansing agent remains controversial, especially the use of antiseptics has been questioned. This article reviews the current literature on the use of antiseptics particularly povidine iodine in traumatic wound cleansing and discusses the beneficial and harmful effects of such practice.

Topics: Acute Disease; Anti-Infective Agents, Local; Antisepsis; Clinical Trials as Topic; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Evidence-Based Medicine; Fibroblasts; Humans; Iodine; Patient Selection; Povidone-Iodine; Skin Care; Therapeutic Irrigation; Wound Healing; Wound Infection; Wounds, Penetrating

To evaluate the efficacy and safety of a topical ophthalmic suspension combination of povidone-iodine 0.6% (PVP-I) and dexamethasone 0.1% (DEX) for infectious and inflammatory components of bacterial conjunctivitis.. Randomized, double-masked, multicenter, phase 3 clinical trial.. Subjects of all ages (those <3 months had to be full-term) with a diagnosis of bacterial conjunctivitis were randomized 3:1:3 to either PVP-I/DEX, PVP-I alone, or placebo. The primary endpoint was clinical resolution in the study eye, and the key secondary efficacy endpoint was bacterial eradication, both at the day 5 visit. Adverse events (AEs) were documented at all visits.. Overall, 753 subjects were randomized (intent-to-treat [ITT] population; PVP-I/DEX [n = 324]; PVP-I [n = 108]; placebo [n = 321]); mean and standard deviation (SD) age was 44.3 (22.9) years, and most were female (61.2%) and white (78.1%). In all treatment groups, mean treatment compliance was >98%. The modified ITT population for the efficacy analysis comprised 526 subjects. In the study eye at the day 5 visit, clinical resolution was achieved by 50.5% (111/220) subjects in the PVP-I/DEX group vs 42.8% (95/222) in the placebo group (P = .127), and bacterial eradication was achieved by 43.3% (94/217) and 46.8% (102/218), respectively (P = .500). Treatment-emergent AEs were experienced by 32.8% (106/323), 39.8% (43/108), and 19.0% (61/321) of subjects in the safety population treated with PVP-I/DEX, PVP-I, and placebo, respectively (most mild in severity).. In this study, PVP-I/DEX did not demonstrate additional benefit in clinical efficacy compared with placebo in subjects with bacterial conjunctivitis.

Topics: Acute Disease; Administration, Ophthalmic; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Conjunctivitis, Bacterial; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Glucocorticoids; Humans; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Treatment Outcome

To evaluate the efficacy/safety of an ophthalmic suspension of povidone-iodine (PVP-I) 0.6% and dexamethasone 0.1% in patients with acute adenoviral conjunctivitis.. Multicenter, randomized, vehicle-controlled, double-masked trial.. Adults with a positive Rapid Pathogen Screening Adeno-Detector Plus test were randomized 1:1:1 to PVP-I 0.6%/dexamethasone 0.1%, PVP-I 0.6%, or vehicle, bilaterally 4 times daily for 5 days (days 1-5). Patients were evaluated on days 3, 6, and 12 (+1-day window). Efficacy measures included clinical resolution and adenoviral eradication.. Overall, 144 patients were included in the efficacy analysis (PVP-I/dexamethasone, n = 48; PVP-I, n = 50; vehicle, n = 46). The proportion of patients with clinical resolution (primary study eye with last observation carried forward [LOCF]) at the day 6 visit was higher with PVP-I/dexamethasone (31.3%) than with vehicle (10.9%; P = .0158) and PVP-I (18.0%; P = nonsignificant). The proportion with adenoviral eradication (primary study eye with LOCF) was higher with PVP-I/dexamethasone than with vehicle at the day 3 (35.4% vs 8.7%; P = .0019) and day 6 (79.2% vs 56.5%; P = .0186) visits and vs PVP-I (day 3 visit, 32.0%; day 6 visit, 62.0%; each P = nonsignificant). Treatment-emergent adverse events (AEs) occurred in 69.0% (vehicle), 62.7% (PVP-I), and 53.4% (PVP-I/dexamethasone) of patients in the safety dataset. Discontinuation owing to AEs occurred in 37 patients (vehicle, n = 16; PVP-I, n = 12; PVP-I/dexamethasone, n = 9).. PVP-I/dexamethasone appeared safe and well tolerated, and significantly improved clinical resolution and adenoviral eradication in patients with acute adenoviral conjunctivitis.

Topics: Acute Disease; Adenovirus Infections, Human; Adenoviruses, Human; Administration, Ophthalmic; Adult; Anti-Infective Agents, Local; Conjunctivitis, Viral; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Treatment Outcome

To determine the efficacy of combination povidone-iodine (PVP-I) 1.0% eyedrops and dexamethasone 0.1% eyedrops in the treatment of adenoviral keratoconjunctivitis.. In a prospective, randomized, controlled, double-blinded clinical trial patients with recent adenoviral keratoconjunctivitis (diagnosed clinically and confirmed by PCR), we randomly divided into three treatment groups: study group - received PVP-I 1.0% and dexamethasone 0.1%, control 1 group - received dexamethasone 0.1% and control 2 group - received lubricating eyedrops (hypromellose 0.3%). The treatment was administered four times a day in each group. All patients were examined and filled a questionnaire before treatment and on the 3rd, 5th and 7th days of treatment.. We included in the study 78 eyes (26 in each group). Adenovirus type 8 was the most common pathogen (83% of cases). The fastest improvement in patients red eyes, discharge, superficial punctate keratitis and pseudomembranes was observed in the study group (p < 0.001). Those patients reached a near complete recovery in 5-7 days, which was also confirmed by reduction in Adenovirus titres by PCR. The slowest improvement was in the control 2 group. Subepithelial infiltrates (SEI) were observed in 44% of the control 1 group, 20% of the control 2 group and in 0% of the study group. The rate of reduction in Adenovirus titres was the slowest in the control 1 group.. The combination of PVP-I 1.0% and dexamethasone 0.1% four times a day can reduce symptoms and expedite recovery in epidemic keratoconjunctivitis patients.

Topics: Acute Disease; Adenoviridae; Adenoviridae Infections; Adult; Anti-Infective Agents, Local; Dexamethasone; DNA, Viral; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Eye Infections, Viral; Female; Follow-Up Studies; Glucocorticoids; Humans; Keratoconjunctivitis; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Treatment Outcome

The objective of this pilot study was to determine the preliminary efficacy of a novel ophthalmic suspension containing povidone-iodine 0.4% and dexamethasone 0.1% in the treatment of adenoviral conjunctivitis.. A prospective, open-label, single-armed, phase II clinical trial in humans. Eligible patients with the clinical signs and symptoms of acute conjunctivitis who tested positive for adenoviral antigen by Rapid Pathogen Screening (RPS) Adeno Detector were enrolled in a single treatment arm consisting of a combination povidone-iodine 0.4%/dexamethasone 0.1% sterile ophthalmic suspension given four times daily for a minimum of 5 days. RPS Adeno Detector testing was performed at baseline and at each follow-up visit along with ocular fluid sampling by conjunctival swabs. Subsequent analysis performed on all swabs included both adenoviral titer by quantitative polymerase chain reaction (qPCR) and cell culture with confirmatory immunofluorescence (CC-IFA). The primary endpoint was clinical resolution of conjunctival injection and discharge. Secondary measures included reduction of qPCR titers and eradication of infectious virus as determined by CC-IFA.. A total of nine eyes of six patients with clinical signs and symptoms of acute viral conjunctivitis and a positive RPS Adeno Detector test result were enrolled in the study. In eight/nine eyes enrolled in the study, clinical resolution was observed by day 3 or day 4. In six/six eyes with detectable adenovirus by qPCR, significant reduction in viral titer was seen by day 3, day 4, or day 5. In five/six eyes with infectious virus confirmed by CC-IFA at enrollment, elimination of infectivity was achieved by day 4 or day 5. One patient was lost to followup.. An ophthalmic suspension containing povidone-iodine 0.4% and dexamethasone 0.1% may be a useful agent in the treatment of acute RPS Adeno Detector-positive conjunctivitis. A further placebo-controlled study with a larger number of patients is warranted.

Topics: Acute Disease; Adenovirus Infections, Human; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Conjunctivitis, Viral; Dexamethasone; Drug Administration Schedule; Drug Combinations; Fluorescent Antibody Technique; Humans; Ophthalmic Solutions; Pilot Projects; Polymerase Chain Reaction; Povidone-Iodine; Prospective Studies; Treatment Outcome

In the years before 1981, the mortality of acute necrotizing pancreatitis was about 70%. By better timing of surgery and intra- as well as postoperative rinsing with povidone-iodine mortality could be lowered to 50%. Leaving the peritoneal cavity open enables easy surgical access to further septic complications. In 10 patients with conservative closure of the abdominal wall five patients died. In seven patients whose abdominal wall was left open and the pancreatic space packed, with the possibility of endoscopic removal of further necroses, only one patient died.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Humans; Male; Mediastinoscopy; Middle Aged; Necrosis; Pancreas; Pancreatitis; Postoperative Complications; Povidone; Povidone-Iodine; Tampons, Surgical

One-hundred consecutive patients undergoing appendicectomy either electively or for clinically diagnosed acute appendicitis were studied to examine the difference between the use of topical povidone-iodine (PVP-I) and ampicillin in the wound given at the time of closure. All patients were treated with metronidazole suppositories for 48 h starting at the time of pre-medication in addition to a topical agent. The overall wound infection rate was 14%. If the appendix was histologically normal or inflamed, the rate fell to 10% whereas if gangrenous or perforated it rose to 24%. Sixty-six per cent of the patients with a perforated appendicitis developed a wound infection. There was no significant difference in the wound infection rate between those treated with PVP-I and those with ampicillin. Topical antisepsis using PVP-I is preferable to ampicillin as it abolishes the risk of antibiotic resistance or allergy developing and since it is comparatively more cost-effective.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents; Anti-Infective Agents, Local; Appendectomy; Child; Drug Therapy, Combination; Humans; Male; Metronidazole; Middle Aged; Povidone; Povidone-Iodine; Surgical Wound Infection

A trial was conducted to compare the effectiveness of povidone iodine and chlorhexidine gluconate with buffered peroxyborate in the treatment of acute ulcerative gingivitis. After 20 patients had entered the trial and 11 had required additional therapy with metronidazole to control their symptoms, the study was terminated. Those patients receiving peroxyborate all showed a satisfactory improvement in clinical signs and symptoms. One patient each receiving povidone iodine or chlorhexidine reported a symptomatic improvement, although gingival ulceration was still apparent at 1 week. The remaining patients all required metronidazole therapy to control their symptoms. Povidone iodine and chlorhexidine gluconate therefore cannot be recommended for the treatment of acute ulcerative gingivitis.

Topics: Acute Disease; Biguanides; Borates; Chlorhexidine; Clinical Trials as Topic; Drug Evaluation; Gingivitis; Gluconates; Humans; Mouthwashes; Povidone; Povidone-Iodine

Topics: Acute Disease; Eating; Humans; Hypothyroidism; Povidone-Iodine

To investigate whether repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling surgery minimizes ocular surface bacterial contamination at completion of the procedure. A total of 489 consecutive eyes that underwent scleral buckling at a single institution were categorized into two groups according to the intraoperative ocular surface washing method used during two separate time periods--a group using physiological saline (saline group, 222 consecutive eyes) and a group using 0.25 % povidone-iodine (PI group 267, consecutive eyes). In 37 eyes of each group, ocular surface fluids were sampled at the beginning of surgery and at completion of buckling, and subjected to bacteriological culture. Acute scleral buckle infection occurred in one patient, and was caused by Pseudomonas aeruginosa. The incidence of acute scleral buckle infection was 0.45 % (1/222 eyes) in the saline group, and 0 % in the PI group, with no significant difference (P = 0.4540). The bacterial detection rates in ocular surface fluid at the beginning of surgery were 5.4 % (2/37 eyes) using saline and 8.1 % (3/37 eyes) using povidone-iodine, with no significant difference (P = 0.6433). The rates at completion of buckling were 18.9 % (7/37 eyes) using saline and 0 % (0 eye) using povidone-iodine, with a significant difference (P = 0.0114). Repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling procedure reduced the ocular surface bacterial contamination rate to an extremely low level at completion of buckling, suggesting that this method is useful for the prevention of acute scleral buckle infection.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Child; Disinfection; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Scleral Buckling; Therapeutic Irrigation; Young Adult

This study evaluated the efficacy of a dilute Betadine (Purdue Pharma, Stamford, Conn) lavage in preventing early deep postoperative infection after total hip (THA) and knee (TKA) arthroplasty. A protocol of dilute Betadine lavage (0.35%) for 3 minutes was introduced to the practice of the senior author in June 2008. A total of 1862 consecutive cases (630 THA and 1232 TKA) performed before this were compared with 688 consecutive cases (274 THA and 414 TKA) after for the occurrence of periprosthetic infections within the first 90 days postoperatively. Eighteen early postoperative infections were identified before the use of dilute Betadine lavage, and 1 since (0.97% and 0.15%, respectively; P = .04). There were no significant demographic differences between the 2 groups. Betadine lavage before wound closure may be an inexpensive, effective means of reducing acute postoperative infection after total joint arthroplasty.

Topics: Acute Disease; Anti-Infective Agents, Local; Female; Humans; Male; Middle Aged; Povidone-Iodine; Prosthesis-Related Infections; Retrospective Studies; Therapeutic Irrigation; Wound Closure Techniques

Topics: Acute Disease; Anti-Infective Agents; Antibiotic Prophylaxis; Cataract Extraction; Ciprofloxacin; Endophthalmitis; Eye Infections, Bacterial; Humans; Incidence; Lens Implantation, Intraocular; Povidone-Iodine; Retrospective Studies; Texas

Continuous irrigation has been used worldwide for the treatment of acute poststernotomy mediastinitis. However, its high rate of failure led to the development of new methods, among them closed drainage with Redon catheters.. We evaluated the results obtained with Redon catheters in 70 patients, and compared them to those obtained in 38 patients treated with continuous irrigation.. The two treatment groups were not different for age, type of cardiac operation, and initial severity of illness. Local failure of Redon catheter drainage occurred less frequently (20 of 38 versus 9 of 70 patients; p = 0.0001). This reduced failure rate was mainly attributable to a lower incidence of superinfections (10 of 38 versus 2 of 70 patients; p = 0.0002), but also to a lower incidence of primary failure (10 of 38 versus 7 of 70 patients; p = 0.026). Mortality was significantly decreased (15 of 38 versus 12 of 70 patients; p = 0.01). The other major advantage of this technique was the simplicity of its use.. The technique using Redon catheters should be considered an effective and convenient treatment of acute poststernotomy mediastinitis.

Topics: Acute Disease; Catheterization; Female; Humans; Male; Mediastinitis; Middle Aged; Postoperative Complications; Povidone-Iodine; Retrospective Studies; Sternum; Suction; Surgical Wound Infection; Therapeutic Irrigation; Treatment Failure; Treatment Outcome

Topics: Acute Disease; Animals; Bile; Blood; Cholestasis, Extrahepatic; Common Bile Duct; Dogs; Female; Ligation; Male; Povidone; Povidone-Iodine; Surgical Wound Infection

Axillary skin lesions can cause significant morbidity in patients with acute nonlymphocytic leukemia. The incidence in relation to the level of circulating granulocytes and the microbiology of 15 such lesions among 150 patients over a three year period were determined. Lesions occurred predominantly during periods of profound granulocytopenia (0-499 cells/microliter). Gram-negative bacilli were the most common pathogens isolated from these lesions. The initiation of a supervised preventive program for 84 patients over 19 months which includes the regular swabbing of each axilla with povidone-iodine cotton sticks in addition to measures to avoid skin trauma has virtually eliminated inflammatory axillary lesions in this high risk patient population.

Topics: Acute Disease; Adult; Agranulocytosis; Axilla; Bacterial Infections; Humans; Hygiene; Leukemia; Povidone-Iodine; Skin; Skin Diseases, Infectious

Topics: Acute Disease; Appendicitis; Humans; Postoperative Complications; Povidone-Iodine; Surgical Wound Infection

Topics: Acute Disease; Ampicillin; Appendectomy; Appendicitis; Cross Infection; Humans; Povidone; Povidone-Iodine; Surgical Wound Infection; Tetracycline