povidone-iodine and Burns

Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after initial resuscitation) result from infection. Antiseptics are topical agents that act to prevent growth of micro-organisms. A wide range are used with the intention of preventing infection and promoting healing of burn wounds.. To assess the effects and safety of antiseptics for the treatment of burns in any care setting.. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting.. We included randomised controlled trials (RCTs) that enrolled people with any burn wound and assessed the use of a topical treatment with antiseptic properties.. Two review authors independently performed study selection, risk of bias assessment and data extraction.. We included 56 RCTs with 5807 randomised participants. Almost all trials had poorly reported methodology, meaning that it is unclear whether they were at high risk of bias. In many cases the primary review outcomes, wound healing and infection, were not reported, or were reported incompletely.Most trials enrolled people with recent burns, described as second-degree and less than 40% of total body surface area; most participants were adults. Antiseptic agents assessed were: silver-based, honey, Aloe Vera, iodine-based, chlorhexidine or polyhexanide (biguanides), sodium hypochlorite, merbromin, ethacridine lactate, cerium nitrate and Arnebia euchroma. Most studies compared antiseptic with a topical antibiotic, primarily silver sulfadiazine (SSD); others compared antiseptic with a non-antibacterial treatment or another antiseptic. Most evidence was assessed as low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, often in single studies. Antiseptics versus topical antibioticsCompared with the topical antibiotic, SSD, there is low certainty evidence that, on average, there is no clear difference in the hazard of healing (chance of healing over time), between silver-based antiseptics and SSD (HR 1.25, 95% CI 0.94 to 1.67; I. It was often uncertain whether antiseptics were associated with any difference in healing, infections, or other outcomes. Where there is moderate or high certainty evidence, decision makers need to consider the applicability of the evidence from the comparison to their patients. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Apitherapy; Bacterial Infections; Bandages; Burns; Chlorhexidine; Disinfectants; Honey; Humans; Merbromin; Plant Preparations; Povidone-Iodine; Randomized Controlled Trials as Topic; Silver Sulfadiazine; Sodium Hypochlorite; Sulfadiazine; Wound Healing

Infection is of primary concern to those practitioners treating burns patients, as it is one of the primary complications associated with acute wounds and particularly with superficial partial-thickness burns. In the fight to reduce the risks, many practitioners deploy common antimicrobials agents prophylactically to help reduce risks, e.g. povidone-iodine. This review will examine the evidence to support this practice. The deployment of povidone-iodine in wound care is highly controversial, with questions being raised concerning not only the effectiveness of the product but also its safety and effect on wound healing. The use of povidone-iodine has been investigated both in vitro and in vivo, resulting in conflicting and often contradictory results. Of the work completed to date, researchers have failed to identify or control for extraneous variables which makes it difficult to compare and interpret research findings. The potential benefits or harm that the use of povidone-iodine may elicit in acute wounds is yet to be established.

Topics: Anti-Infective Agents, Local; Burns; Humans; Povidone-Iodine; Trauma Severity Indices

A critical elevation of povidone-iodine absorption which occurred in a burn patient who was topically treated with 10% povidone-iodine (PI) gel is herein reported. A 65-year-old man was admitted to our hospital for deep second- and third-degree burns covering 26% of his total body surface area. The intravenous administration with lactated Ringer's solution and topical treatment with silver sulfadiazine were applied in addition to such treatments as debridement and skin grafting. However, wound infection occurred due to Pseudomonas aeruginosa. Topical treatment with PI gel was effective for this condition. Persistent nodal bradycardia with hypotension, metabolic acidosis, and renal failure occurred 16 days after the start of PI gel treatment. Iodine toxicosis caused by PI gel was suspected with a serum iodine level of 20600 microg/dl (normal range 2-9 microg/dl). The PI gel treatment was therefore discontinued immediately, and hemodialysis was scheduled. However, the patient's family refused hemodialysis and he died 44 days after admission. To our knowledge, only eight patients with iodine toxicosis have been reported in burn patients treated with PI gel.

Topics: Absorption; Acidosis; Aged; Anti-Infective Agents, Local; Bradycardia; Burns; Debridement; Fatal Outcome; Gels; Humans; Hypotension; Iodine; Male; Povidone-Iodine; Pseudomonas Infections; Renal Insufficiency; Silver Sulfadiazine; Skin Transplantation; Wound Infection

The natural element iodine has been used for more than 150 years to prevent infection and treat wounds. Yet only due to the development of iodophors has it become possible to use this highly efficient microbicide in a wide range of medical applications. The antimicrobial spectrum is universal. Its efficiency against clinically and epidemiologically significant new pathogens, such as methicillin-resistant Staphylococcus aureus and Enterococcus sp. has also been validated. No development of resistance has been determined. New data are also available on the excellent local tolerability of Betaisodona (povidone-iodine) preparations. On these grounds, a number of clinical fields exist in prophylaxis and therapy, for either once only or repeated applications: the disinfection of hands and skin, mucosa antisepsis, intra- and postoperative wound treatment, therapy of skin infections, burns and chronic wounds.

Topics: Anti-Infective Agents, Local; Antisepsis; Bacterial Infections; Burns; Chronic Disease; Enterococcus; Gram-Positive Bacterial Infections; Hand; Humans; Intraoperative Care; Iodophors; Methicillin Resistance; Mucous Membrane; Postoperative Care; Povidone-Iodine; Skin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

In recent years, liposomes have been increasingly explored as novel drug delivery systems, and several liposome-based drug products have been approved in Europe, the USA and Japan. Depending on size, composition and surface characteristics, liposomes interact specifically with biological structures. Liposomal drug products provide a topical activity at the desired locus of action and are deemed more effective and less toxic than conventional drug formulations. The combination of povidone-iodine (PVP-I) and liposomes unites the exceptional microbicidal activity of the antiseptic substance with the excellent tolerability and lack of immunogenicity of liposomes; in addition, liposomes provide a moist molecular film for the wound environment. The multilamellar vesicles act as microreservoirs hence prolonging the release of the active ingredient. Although no commercial product for repeated application on the eye is currently available, PVP-I has been used in ophthalmology not only for pre- and postoperative antisepsis, but also for the treatment of bacterial and viral conjunctivitis and for prophylaxis against ophthalmia neonatorum. For these indications, liposomal formulations with 2.5 and 5.0% PVP-I were developed. These eye drops are isotonic with tear fluid at pH 6. First in vitro tests demonstrated an excellent antimicrobial efficacy, and a placebo-controlled clinical study on volunteers showed a very good local tolerability. A study on rabbits demonstrated positive results of the PVP-I liposome eye drops compared to placebo and the broadspectrum antibiotic Polyspectran in a standardized model of Staphylococcus aureus deep eye infection. The other aim is a well-tolerated liposomal PVP-I hydrogel for improved antiseptic wound treatment with moisturizer. It has been reported that liposomes are enriched at the wound bottom for direct action against infection and support of wound healing. An animal study on the efficacy and tolerability of different formulations of a hydrogel with PVP-I liposomes in deep dermal burn wounds has indicated an outstanding quality of wound healing with smooth granulation tissue, less inflammation, less wound contraction and no hyperkeratotic reactivity, especially with the 3% PVP-I liposome formulation.

Topics: Administration, Cutaneous; Administration, Topical; Animals; Anti-Infective Agents, Local; Burns; Clinical Trials as Topic; Conjunctivitis, Bacterial; Conjunctivitis, Viral; Delayed-Action Preparations; Drug Approval; Drug Carriers; Drug Delivery Systems; Europe; Eye Infections, Bacterial; Humans; Infant, Newborn; Iodophors; Japan; Liposomes; Ophthalmia Neonatorum; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Placebos; Povidone-Iodine; Rabbits; Skin; Staphylococcal Infections; United States; Wound Healing; Wound Infection

Local infection and burn wound sepsis are one of the most severe problems in the treatment of thermally injured patients. Early surgical treatment and the use of topical antiseptics led to a decrease in the infection rate and significantly improved the survival rate of burns patients within the last twenty-five years. Many antiseptics are used in the treatment of burns. Silver nitrate, silver sulphadiazine, sulfamylon and povidone-iodine (PVP-I) are the most common substances used worldwide in burn care facilities. Clinical studies demonstrate that treatment with PVP-I is the most effective against bacterial and fungal infection. Several methodological problems however arise from direct comparison between these antiseptics, and local and systemic adverse effects can make the right choice difficult. Some case reports documented possible side effects in the treatment of patients with PVP-I, leading to general concerns about this treatment. Absorption of iodine and possible changes in thyroid hormones are well known, but evaluation of the clinical consequences is controversial. Reports of severe metabolic acidosis and renal insufficiency with lethal results have condemned the use of PVP-I in the treatment of extensive burns. The case reports, however, dealt with patients suffering from general morbidity and sepsis and therefore these single reports may not be generally valid. Local treatment of burns may cause further problems. The beneficial effect of a decrease of bacterial counts in deeper tissue may be confounded by other effects delaying wound healing, as shown in some experimental studies. Controlled clinical investigations on burn patients however are still missing. The paper will discuss these topics in detail referring to the treatment of burns with PVP-I. It is based on a critical review of the literature and the author's own experience in burns therapy.

Topics: Acid-Base Imbalance; Adult; Aged; Antisepsis; Burns; Female; Humans; Male; Povidone-Iodine; Thyroid Gland; Wound Healing; Wound Infection

Topics: Administration, Topical; Anti-Bacterial Agents; Burns; Cerium; Gentamicins; Humans; Mafenide; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine; Wound Infection

Due to a partial rejection of mesh split-thickness skin grafts (mesh grafts) after application of povidone-iodine and silver nitrate and due to its better in vitro tolerance, polihexanide was investigated as an alternative and its applicability in the treatment of second-degree burn wounds.. In 4 patients with poorly healing decubitus ulcers the mesh grafts were each divided into three areas which were pre-treated with either undiluted povidone-iodine solution, 1% silver nitrate solution or 0.04% polihexanide solution. After 7 days of application the wound areas were compared clinically and histologically. Thereafter 14 patients (average extent of burns 28% TBSA) were treated in the same way.. Clinically and histologically the mesh grafts treated with polihexanide showed by far the best re-epithelialization compared with the deep tissue necrosis and marked fibrin discharge observed for application of povidone-iodine and silver nitrate. The second-degree burn wounds treated with polihexanide epithelialized without any further débridement after an average of 10 days with remarkable freedom from pain. Compared with silver nitrate treatment, no fibrin film was observed on the wound.. Polihexanide proved clinically and histologically superior to povidone-iodine and silver nitrate. For the treatment of second-degree burns, which cannot primarily be covered by plastic surgery, polihexanide is suitable because in addition to its antiseptic efficacy it does not inhibit the re-epithelialization process.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Biguanides; Burns; Epithelium; Female; Humans; Male; Middle Aged; Povidone-Iodine; Silver Nitrate; Skin Transplantation; Wound Healing

Local treatment of burn injuries with conventional anti-infective preparations does not provide the moist environment that promotes fast wound healing. In a randomized controlled trial the effects of liposome polyvinyl-pyrrolidone-iodine (PVP-I) hydrogel, a novel formulation of PVP-I in a liposome hydrogel with high water-binding capacity, were investigated in 43 patients with partial-thickness burn wounds in an intraindividual comparison with a conventional silver-sulfadiazine cream. Treatment with liposome PVP-I hydrogel resulted in significantly faster complete healing of the burn wounds compared with silver-sulfadiazine cream (9.9 +/- 4.5 days versus 11.3 +/- 4.9; P < 0.015). The cosmetic result (smoothness, elasticity, appearance) was rated as excellent for 37.0% of study wounds with liposome PVP-I hydrogel compared with 13.0% of wounds treated with silver-sulfadiazine cream. Local tolerability was good; handling and change of dressing were rated as easy. Local treatment with liposome PVP-I hydrogel thus provides fast wound healing with a favorable cosmetic result.

Topics: Adult; Anti-Infective Agents, Local; Burns; Female; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Liposomes; Male; Middle Aged; Povidone-Iodine; Silver Sulfadiazine; Treatment Outcome; Wound Healing

A new hydrosome wound gel is based on a new mechanism of action. It contains hydrosomes that penetrate to the wound bed and supply the wound with phospholipids, which are identical to membrane phospholipids of human cells. In this manner it supports the proliferative processes during wound healing.. In a randomized, controlled, intraindividual comparative study of 47 patients with grade IIa burns, the hydrosome wound gel was tested against silver sulfadiazine cream. Digital pictures of the burn wounds were taken daily, and the wounds were analyzed in terms of their reepithelization rate.. Wounds receiving the hydrosome wound gel healed 1.5-2 days faster than wounds treated with sulfadiazine cream (9.9+/-4.5 days vs. 11.3+/-4.9 days, p=0.015). In 66% of the patients, faster epithelization was observed with the hydrosome wound gel treatment. The hydrosome gel guaranteed secure prophylaxis against infection, and it was well tolerated and easy to apply.. In this study, the treatment of grade IIa burn wounds with hydrosome wound gel led to faster wound closure compared with treatment with sulfadiazine cream. Therefore, hydrosome gel represents a good alternative to sulfadiazine cream.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Burns; Child; Child, Preschool; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Liposomes; Middle Aged; Povidone; Povidone-Iodine; Silver Sulfadiazine; Wound Healing; Wound Infection

Moist wound treatment improves healing at a possibly increased risk of bacterial infection and many local antiseptics impair healing. A moist treatment modality with efficient antimicrobial activity would be desirable.. In this monocentric, randomized, observer blinded, phase III study, a new hydrosome polyvinyl-pyrrolidone (PVP)-iodine preparation in hydrogel containing iodine in a 3% concentration (Repithel) was investigated for its effect on epithelialization in patients receiving meshed skin grafts. Grafts of 167 patients (donor site defects, burn wounds, or chronic defects) were dressed either with Repithel (n=83) covered with a gauze (Jelonet), or Jelonet-gauze only (n=84) until healing.. Grafts receiving Repithel healed significantly earlier (9.4 days versus 12.4 days; p<0.0001) and faster than controls as measured by neo-epithelialization of mesh holes between days 7 and 11 (91.2+/-22.8% versus 82.3%+/-28.6, p<0.0001). A subgroup analysis showed that the effects on grafted burn wounds (p=0.0042) and chronic defects (p<0.0001) was more significant than on donor sites. Also a higher take rate of grafts (p=0.0053) and a reduced loss of grafts was observed with Repithel treatment (8 grafts versus 20 grafts) (p=0.0063, respectively). Smokers had improved graft take (p=0.0069) and higher rate of epithelialization (p=0.0040) compared to smokers of the control group.. The results demonstrate significant clinical advantages of Repithel. This new local wound healing drug combines antisepsis and wound moisture efficiently resulting in significantly enhanced epithelialization, decreased transplant losses, and significantly improved healing especially in smokers.

Topics: Anti-Infective Agents, Local; Burns; Epithelium; Female; Graft Survival; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Male; Middle Aged; Povidone-Iodine; Single-Blind Method; Skin Transplantation; Surgical Mesh; Wound Healing

Six hundred thirteen patients with deep burn of up to 50% total body surface area (TBSA) were treated with 0.25% povidone iodine subeschar clysis (PVP-SEC) in addition to surface application of povidone iodine + Neosporin in the form of "crust". The results were compared with those of 595 age, sex and percentage of burn, matched patients treated only by "crust application". The quantitative bacterial count showed significantly less incidence of infection on the 7th and 8th days post treatment (P<0.001). The organisms identified were predominately Staphylcocous aureus and Pseudomonas aeroginosa. Significantly more number of patients, with burns up to 50% TBSA, could be grafted within 20 days in the SEC group. The graft acceptance rate in this group was 90%.

Topics: Adult; Anti-Infective Agents, Local; Bacitracin; Bacterial Infections; Burns; Drug Combinations; Female; Humans; Male; Neomycin; Polymyxin B; Povidone-Iodine; Skin Transplantation; Treatment Outcome

Effective local treatment is very important in preventing wound infection and its generalization and ensuring successful skin grafting. The aim of our study is to compare the activity of four topical agents [deflamol (20 patients), polyvidone-iodine (21 patients), flammazine (silver sulphadiazine--SSD) (28 patients) and flammacerium (SSD with cerium nitrate) (five patients)] for treatment of patients with burns by confirming our clinical observations of their efficacy with comparative bacteriological investigations. The final estimation of our results showed the undoubted priority of flammazine and flammacerium over deflamol and polyvidone-iodine, as the treatment of all the patients with these two drugs gave very good and good results, respectively. In contrast, the results in 70% of the patients from the deflamol group and in 52.4% of those from the polyvidone-iodine group were unsatisfactory. At this stage we cannot find any significant differences in the antibacterial activity between flammazine and flammacerium. However, the excision of the firm eschars formed by flammacerium is easier and it gives the opportunity to postpone operation for a month or more. In conclusion we found suitable indications for preference of each of the topical agents included in our study.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bulgaria; Burn Units; Burns; Cerium; Child; Child, Preschool; Drug Combinations; Female; Follow-Up Studies; Humans; Infant; Injury Severity Score; Male; Middle Aged; Ointments; Povidone-Iodine; Silver Sulfadiazine; Treatment Outcome; Wound Healing; Wound Infection

A prospective trial was conducted to compare a new povidone iodine impregnated dressing (Inadine) with a standard petroleum jelly gauze dressing for small superficial burns treated on an outpatient basis. The results show no difference between comfort and ease of removal of dressings, in the number of positive bacteriological cultures or the number of days to healing. Inadine is more than twice as expensive as petroleum jelly gauze.

Topics: Adolescent; Adult; Bandages; Burns; Child; Child, Preschool; Clinical Trials as Topic; Delayed-Action Preparations; Evaluation Studies as Topic; Humans; Infant; Povidone; Povidone-Iodine

A trial comparing three topical agents was carried out in patients with burns. The substances investigated were 10% povidone-iodine (PVP-I) ointment mixed with a proteolytic agent, 5% PVP-I cream alone and in combination with the same proteolytic agent. Differences were observed in healing times and bacteriological cultures. Shorter healing times were observed in burns treated with PVP-I cream. The addition of a proteolytic agent to the cream made no difference to the results. Fewer positive cultures for Staphylococcus aureus and Pseudomonas aeruginosa were obtained in the groups treated with the cream. It was concluded that 5% PVP-I cream is a safe and effective topical agent in burns.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteria; Benzoates; Burns; Child; Child, Preschool; Clinical Trials as Topic; Dosage Forms; Drug Combinations; Humans; Infant; Malates; Middle Aged; Ointments; Povidone; Povidone-Iodine; Salicylates; Wound Healing

In the surgical suture, the implanted thread can be a source of microbial contamination. Implanted materials are frequently described as being substrates prone for biofilm development provoking surgical site infections. Treatment of postsurgical wounds with different topical antimicrobial agents is a current practice applied to every patient. However, to date, there is little evidence on the efficacy of different antiseptic treatments on suture materials in preventing environmental or skin bacterial adhesion and further infection. Here, the authors compared the ability of an aerosol formulation of silver sulfadiazine, vitamin A, and lidocaine (AF-SSD) and of two of the most frequently used topical treatments, povidone-iodine and ethanol, in eradicating or controlling the microbial contamination of suture threads in patients who have undergone clean surgeries. Postsurgical suture threads treated with AF-SSD showed a significantly reduced proportion of contaminated samples containing viable microbial cells compared with those treated with povidone-iodine or ethanol. Furthermore, those samples that were positive for bacterial growth showed a lesser number of viable cells in AF-SSD-treated sutures than those treated with povidone-iodine or ethanol. Confocal laser scanning microscopy showed that AF-SSD-treated postsurgical sutures presented significantly less attached microbial cells than povidone-iodine and ethanol, with scarce observable microbial cells on the surface of the suture. Taken together, the results suggest that treatment with AF-SSD is more effective than the other two antiseptics, and there is a potential for improvement in reducing the microbial burden of implanted materials such as the suture thread.

Topics: Administration, Topical; Aerosols; Anti-Infective Agents, Local; Burns; Ethanol; Follow-Up Studies; Humans; Povidone-Iodine; Silver Sulfadiazine; Surgical Wound Infection; Sutures; Wound Healing

Bacterial nanocellulose (BNC) is considered a promising carrier for various substances and novel approaches using BNC in combination with antiseptics are well documented. However, the difference in the molecular weight of these molecules influences their uptake by and release from BNC. Analysing the diffusion of standard molecules with different weight, e.g. dextrans, offers the possibility to investigate the mobility of various molecules. We aimed to test the use of BNC regarding uptake and release of different standard molecules as well as two commercially available antiseptics for possible applications in future wound dressings.. Diffusion profiles, uptake and release of three FITC-dextran molecules differing in weight as well as octenidine (Octenisept®) and povidone-iodine (Betaisodona®)-based antiseptics were tested with BNC-based wound dressings. Furthermore, the antiseptic efficacy of BNC in combination with antiseptics against Staphylococcus aureus was tested.. Uptake and release capacity for FITC-dextran molecules showed a molecular weight-dependent mobility from BNC into an agarose gel. The loading capacity of BNC was also inversely proportional to the molecular weight of the antiseptics. The release test for octenidine showed a sustained and prolonged delivery into a solid matrix, whereas povidone-iodine was released faster. Both antiseptic solutions combined with BNC showed a good dose-dependent efficacy against S. aureus.. Results obtained from the mobility of FITC-dextran molecules in the BNC matrix could open possible applications for the combination of BNC with other molecules for medical applications. Combination of both tested antiseptics with BNC showed to be an efficient approach to control bacterial infections.

Topics: Anti-Infective Agents, Local; Bandages; Burns; Cellulose; Dextrans; Drug Carriers; Fluorescein-5-isothiocyanate; Humans; Imines; Molecular Weight; Nanostructures; Povidone-Iodine; Pyridines; Wound Infection; Wounds and Injuries

Topics: Anti-Infective Agents, Local; Burns; Chlorhexidine; Humans; Povidone-Iodine; Practice Patterns, Physicians'; Surgical Procedures, Operative; Surveys and Questionnaires; United Kingdom; Wound Infection

The authors devised a comparative prospective study to determine the in vitro microbicidal efficacy of skin preparation solutions in the concentrations and temperatures used in the burns theatre against common bacterial and fungal microorganisms. A panel of 10 microorganisms Staphylococcus aureus, streptococcus pyogenes, enterococcus faecalis, escherichia coli, pseudomonas aeruginosa, candida albicans, bacillus cereus were assembled comprising 8 common strains of S. aureus (including methicillin resistant staphylococcus aureus (MRSA)), S. pyogenes, E. faecalis, E. coli, P. aeruginosa, C. albicans, B. cereus, and multi-drug resistant Klebsiella and Acinetobacter. These were cultured in the following formulations: 1) povidone iodine (PVP-iodine) 10% stored at room temperature (250C), 2) PVP-iodine stored at 40 to 420C, 3) chlorhexidine digluconate stored at room temperature diluted with warmed saline to concentrations of 4%, 2%, 1%, 0.8%, and 0.5%. All 3 formulations met DIN EN (Deutsches Institut für Normung) (European Standards) requirements for antiseptics. Both antiseptics showed the same high bactericidal and fungicidal efficacy (P = < 0.05). For chlorhexidine, all minimum inhibitory concentrations at both 24 and 48 hours were very low (< 0.5mg/L), but for PVP-iodine the minimum inhibitory concentrations were much higher and ranged from 64 to 512 mg/L. All concentrations of chlorhexidine tested were superior to PVP-iodine with no bacterial growth. There was a small amount of growth in some of the PVP-iodine treated groups, but this was not clinically significant.

Topics: Anti-Infective Agents, Local; Bacteria; Burns; Chlorhexidine; In Vitro Techniques; Microbial Sensitivity Tests; Povidone-Iodine; Prospective Studies; Wound Infection

The aim of this study was to evaluate burn wound healing activity of coconut shell liquid smoke (CS-LS) in a burn wound animal model. Burn wound-induced mice were treated with CS-LS (CS-LS group), povidone iodine 10% (povidone group), or NaCl 0.9% (NaCl group). Application of CS-LS promoted wound contraction compared to that of the povidone and NaCl groups ( P < .05). This study showed a positive correlation between the number of fibroblasts and wound contraction. The number of fibroblasts was highest in the CS-LS group, compared to that of the povidone and NaCl groups ( P < .05). In conclusion, CS-LS promotes burn wound healing by one possible mechanism, by increasing the number of fibroblasts. The results indicate that further experimental trials are needed to develop CS-LS as an alternative topical drug for burn wound healing.

Topics: Animals; Burns; Cocos; Fibroblasts; Male; Mice; Povidone-Iodine; Smoke; Wound Healing

A multitude of topical wound treatments are used today. Although it is well established that the micro-environment of healing wounds can be altered to improve healing, it is difficult to measure the subtle differences in outcome where therapies are compared.. We compared wound healing properties between four different topical agents in surgically incised wounds in a pig model. The four topical agents, 5% Povidone-Iodine cream, 1% Silver-Sulphadiazine, 2% Mupirocin, and 1% Silver-Sulphadiazine plus 1mg/100g recombinant-human epithelial growth factor (EGF) were randomly assigned to four test animals each. Test agents were compared to each other and to untreated controls. We investigated existing and new methodologies of measurement of wound healing: clinical and histological visual scoring systems, immuno-histochemistry, and computerized image analysis of the wounds on days 3, 7, and 28.. All agents were found to have improved healing rates with better cellular architecture. Healing was faster, histological appearance resembled normal architecture sooner, clinical appearance improved, mitotic activity was stimulated and more collagen was deposited in comparison to the wounds with no agents. EGF-treated wounds showed an increased rate of epithelisation, but the rate of healing did not correlate well with evaluation of cosmetic outcome.. Topical agents improve all aspects of wound healing. The addition of a human recombinant EGF to Silver-Sulphadiazine increases epithelial growth and amounts of collagen in the regenerating wounds at day 7.

Topics: Administration, Cutaneous; Animals; Anti-Infective Agents; Burns; Cell Proliferation; Dermis; Epidermal Growth Factor; Epidermis; Female; Humans; Image Processing, Computer-Assisted; Immunohistochemistry; Mupirocin; Povidone-Iodine; Re-Epithelialization; Recombinant Proteins; Silver Sulfadiazine; Skin; Swine; Trauma Severity Indices; Wound Healing

In vitro efficacy evaluation of eleven topical antimicrobials against multidrug-resistant (MDR) bacteria isolated from burn wounds of our patients.. Growth of six MDR bacterial strains: Pseudomonas aeruginosa (2 strains), Staphylococcus aureus, Staphylococcus haemolyticus, Enterococcus faecalis and Escherichia coli in burn-wound models was evaluated 24-h after application of the tested agents. Four different wound models were created to investigate the role of time elapsed between inoculation of bacteria and application of the agents on their antimicrobial activity and efficacy.. The efficacy against all the 6 bacteria in freshly contaminated wounds was excellent in majority of the tested agents. The longer was the time interval between inoculation and application of the topical antimicrobial agents, the higher failure of the agents was observed.. Topical antimicrobials play an important role in treatment of burn wounds, but they should be used according to their efficacy against bacterial strains present in patients' wounds. In cases where topical agents have been applied after 24 h, when formation of mature biofilm in the wound could be expected, it would probably not be possible to kill all the bacteria using topical antimicrobial therapy only.

Topics: Acetic Acid; Anti-Infective Agents, Local; Burns; Drug Resistance, Multiple, Bacterial; Enterococcus faecalis; Escherichia coli; Honey; Humans; Imines; Microbial Sensitivity Tests; Nitrofurazone; Povidone-Iodine; Pseudomonas aeruginosa; Pyridines; Silver Sulfadiazine; Staphylococcus haemolyticus

The success of Biobrane (Smith & Nephew, St. Petersburg, Florida) dressing in superficial burns depends on wound selection and preparation. After wound debridement, povidone-iodine is applied, and changes in wound color are recorded. Next, Biobrane is applied, and adherence is checked after 48 hours. The authors' study showed that remaining brown areas of the wound are predictive of Biobrane nonadherence, which is indicative of deeper burns.

Topics: Adolescent; Adult; Burn Units; Burns; Child; Child, Preschool; Coated Materials, Biocompatible; Cohort Studies; Combined Modality Therapy; Debridement; Female; Follow-Up Studies; Humans; Infant; Injury Severity Score; Male; Middle Aged; Occlusive Dressings; Povidone-Iodine; Predictive Value of Tests; Retrospective Studies; Treatment Outcome; United Kingdom; Wound Healing; Young Adult

To study the effect of porcine acellular dermal matrix (ADM) on the burn wound healing. Seventy healthy Wistar rats were inflicted with 2 cm second degree burn and divided into 2 groups; one group was treated with porcine ADM and the other with Povidone Iodine Cream. Biopsies were taken on day 1, 3, 5, 7, 10, 14, 21 for histopathological and biochemical analysis to test PCNA, K19, Integrin-β1, PDGF, EGF and FGF. The results revealed relatively better and faster regeneration after treatment of porcine ADM, along with greatly increased synthesis in collagen in the experimental group. PCNA, K19, Integrin-β1 had an increase and then tapered down, and were stronger in the experimental group than in the contrast group during 21 days after burns. PDGF, EGF and FGF levels increased on day 3, peaked on day 5 and then started to decrease, while significantly enhanced expression of relevant growth factors were observed in the experimental group. Porcine ADM stimulate collagen synthesis, stem cells proliferation and differentiation, and the expression of relevant growth factors and ultimately improve the burn wound healing.

Topics: Acellular Dermis; Administration, Cutaneous; Animals; Biomarkers; Burns; Cell Differentiation; Cell Proliferation; Collagen; Disease Models, Animal; Heterografts; Intercellular Signaling Peptides and Proteins; Povidone-Iodine; Rats; Rats, Wistar; Skin; Skin Cream; Skin Transplantation; Stem Cells; Swine; Time Factors; Wound Healing

Accidental burns in the operating room are hopefully rare events, but it could happen during any surgical procedure. To reduce the nosocomial infection, the use of alcohol-base products is recommended by all the recent guidelines. Yet these inflammables products represent a potential danger if they are not carefully employed, and the surgeon's responsibility can be involved. We therefore thought it would be interesting to show the benefit provided by such products in terms of wound infection and skin preparation. However, two recent cases of severe accidental burn illustrate the importance of precautions when using such products.

Topics: Anti-Infective Agents; Burns; Cross Infection; Female; Humans; Iatrogenic Disease; Intraoperative Complications; Middle Aged; Operating Rooms; Povidone-Iodine; Practice Guidelines as Topic; Risk Factors; Young Adult

Burns are a leading cause of non-natural death in South African infants and children. Conventional care of partial-thickness burns often requires painful, time consuming and costly twice-daily dressing changes to clean the wound and apply antimicrobial topical agents. A new topical nanocrystalline silver-coated NS dressing (Acticoat; Smith & Nephew) has been developed and is the first-line treatment of choice in many burn centres. However, because of its cost the Department of Health has been reluctant to introduce it as a standard of care. We retrospectively studied 4 randomly selected paediatric burn patients, calculating the cost associated with the use of NS dressings and comparing this with the projected costs of three previously standard burn wound treatment regimens. NS dressings were changed every 3 days based on their sustained and slow release of silver ions over 72 hours. Using NS clearly saved costs compared with the three other regimens. The demonstrated cost savings resulted primarily from the decreased number of dressings, and the presumed shorter hospital stay.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Burn Units; Burns; Child; Child, Preschool; Chlorhexidine; Costs and Cost Analysis; Female; Humans; Infant; Male; Mupirocin; Povidone-Iodine; Retrospective Studies; Silver Sulfadiazine; South Africa; Treatment Outcome

Clostridial collagenase A (CCA) has been shown effective in degrading collagen in eschar tissue and promoting healing in partial-thickness burns. As there are also reports of fever, leukocytosis, increased C-reactive protein (CRP) levels and septic complications during treatment with CCA, we aimed to determine in rats whether CCA aggravates the systemic inflammatory response.. Rats with partial-thickness burns were randomly divided into groups with either no dressing (ND), povidone-iodine dressing (PID) or CCA dressing (CCAD). Body weights and temperatures, blood leukocyte counts, and serum levels of CRP, interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha), were measured at 0, 3, and 24h and days 3 and 7 from burn. Wounds were cultured on days 1, 3 and 7 and burn depth was evaluated on day 1.. Body weights for all groups were significantly lower after burn, with highest loss (25.5%) in the CCAD group. At 3h a significant drop in rectal temperature was noted in all groups. The CCAD group had higher rectal temperature levels than the PID group on days 3 and 7 (p<0.05). Changes in serum levels of CRP, IL-1 beta, IL-6 and TNF-alpha were not significant in the ND and PID groups; the CCAD group showed a significant rise in serum levels of CRP on day 1, of IL-6 on day 3 and of TNF-alpha on day 7. Wound infection was more common in CCAD group and increased on days 3 and 7, but this was insignificant.. CCA aggravated the systemic inflammatory response in rats with partial-thickness burns, which is accompanied by a higher risk of infection.

Topics: Animals; Biomarkers; Burns; C-Reactive Protein; Interleukin-1beta; Interleukin-6; Leukocyte Count; Male; Microbial Collagenase; Occlusive Dressings; Ointments; Povidone-Iodine; Random Allocation; Rats; Rats, Wistar; Skin; Tumor Necrosis Factor-alpha; Wound Healing

Despite general reports of fires in the operating room, those during neurosurgical procedures are rare. The most significant contributor to perioperative fires is excess oxygenation. The consideration of novel gel-based surgical preparation solutions as potential fuel sources should be included in the literature. Given the significant patient risk and legal ramifications of surgical fires, education regarding operating room fires and the potential for prevention and treatment is requisite. The authors describe the case of an 18-month-old girl who, while undergoing a resection of a right retroauricular scalp mass, suffered partial thickness bums as a result of the ignition of surgical preparation solution following the use of monopolar electrocautery.

Topics: Administration, Topical; Anti-Infective Agents; Burns; Child; Dermoid Cyst; Drug Combinations; Electrocoagulation; Ethanol; Female; Fires; Gases; Gels; Hair; Hair Removal; Humans; Intraoperative Complications; Operating Rooms; Povidone-Iodine; Preoperative Care; Scalp; Skull Neoplasms

In major burns, local treatment of the split skin graft after a burn injury is important to prevent serious infectious complications. Topical burn wound therapy may improve the bacteriological condition of the wound, which in turn may improve the successful take of a skin graft. Delay of wound healing is an undesired side effect of these topical anti-microbial agents. It is known that povidone-iodine has many clinical advantages. In view of this, the total healing time of the freshly grafted burn wound was studied. In this prospective study, comparable areas of the same patient were treated with povidone-iodine ointment or with simple vaseline gauze. There was no statistical difference in the total wound healing time between the treated and the control group.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Burns; Case-Control Studies; Female; Humans; Male; Petrolatum; Povidone-Iodine; Prospective Studies; Skin; Skin Transplantation; Thyroid Function Tests; Time Factors; Treatment Failure; Wound Healing

Topics: Burns; Humans; Infant; Intensive Care Units, Pediatric; Male; Povidone-Iodine; Thyroid Function Tests; Thyrotoxicosis

In dermatological surgery where the lesions to be removed are very often contaminated with bacteria, local use of antiseptics that are effective against a wide range of germs is often indicated. Polyvinylpyrrolidone (povidone = PVP)-bound iodine (in Hungary marketed as Betadine is used successfully in our department. After excision and suture in per primam healing wounds as well as after tissue destruction in per secundam healing wounds, a thin layer of Betadine ointment on the dressing right after surgery and at dressing changes may reduce the risk of wound infection. When the defect requires split-thickness skin grafting, a combination of tulle gras and a layer of gauze soaked with 1:10 dilution of Betadine solution is suggested. In the treatment of leg ulcers, Betadine is used for cleansing and for impregnating the gauze on top of the tulle gras layer both in the debridement and in the epithelization phases. PVP-I is beneficial on burn wounds due to its effect reducing bacterial colony counts. Its use is advised for superficial (grades 1 and 2a) burns as well as surgical debridement of deep burns or temporary xenograft or definitive autograft coverage of these wounds. After treating a large number of patients with Betadine, a statement can be made: despite its theoretical risk, no cytostatic effect is seen in the clinical setting. No allergy towards Betadine was observed among the author's patients over several years of its use. Fifty patients previously treated with PVP-I were challenged with epicutaneous patch testing, and no sensitization was found. An account is made on the adverse effects attributed to Betadine found in the scientific literature, and its use with regard to the proper indications is suggested.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Burns; Child; Child, Preschool; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Povidone-Iodine; Skin Tests; Surgical Wound Infection

Toxic shock syndrome (TSS) is a rare complication of a Staphylococcus aureus infection and is primarily seen in children with small burns. The true incidence of TSS in burns patients is not known and the number of presumptive cases rarely reported. This survey was undertaken to determine if the incidence of TSS in children with burns could be related to the type of dressing used to cover the wound. A questionnaire was compiled and sent to the Senior Nurse in charge of each of the UK burns units. General information on the number of admissions, age of the patient, cause of injury and burn wound management was sought. An 81% response was obtained after two mailshots and follow up telephone calls. Seventy percent (23/33) of units which answered the survey nursed children. Of these, eight units had either not encountered TSS previously or not had a case within the past two years. These units were small, admitting a maximum of 50 patients each year. Of the units where TSS was encountered, approximately 2.5% of children admitted showed symptoms of TSS. Of the units who nursed both adults and children, seven units had seen TSS in burned adult patients which has not been reported in the literature. Of the eight units where TSS had not been recently encountered, four routinely administered prophylactic antibiotics to prevent infection whereas routine administration of antibiotics occurred in only two of the 15 units where TSS was seen. Although wound management procedures differed slightly there were many similarities. These included wound cleaning with normal saline, covering with either silver sulphadiazine (1%) or povidone iodine (10%), depending upon the infection status, and dressing with a paraffin tulle, gauze and crepe bandages. No association between the management of the burn wound and subsequent development of TSS could be established.

Topics: Adult; Age Factors; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bandages; Burns; Child; Child, Preschool; Detergents; Humans; Incidence; Patient Admission; Povidone-Iodine; Shock, Septic; Silver Sulfadiazine; Sodium Chloride; Surveys and Questionnaires; United Kingdom; Wound Infection

Mustard gas (sulfur mustard, HD) is a powerful vesicant employed as a chemical weapon. The present study demonstrates the effect of povidone iodine (PI) ointment against skin toxicity caused by HD. Gross and histopathological examinations showed that application of PI 20 min or less following exposure to the vesicant resulted in marked skin protection. The shorter, interval between exposure and treatment, the better was the protection achieved. Povidone iodine was also effective against other mustards, such as carboxybutylchloroethyl sulfide (CBCS) and mechlorethamine. The fact that PI protected the skin against agents that cannot be oxidized, such as iodoacetic acid, divinylsulfone and cantharidine, indicated that the antidotal effect of PI was unrelated to oxidation of the nitrogen and sulfur atoms of the mustards. Furthermore, NMR spectroscopy of CBCS treated with iodine did not show oxidation of the sulfur atom. Clinical experience with patients after accidential heat burns (mostly of grade I) has shown that topical application of PI ointment immediately after the stimulus significantly reduced, and often prevented, skin lesions. Apart from being a safe and widely used disinfectant, PI ointment is recommended as an efficient protective agent against skin toxicity caused by hazardous chemicals and by heat stimuli.

Topics: Administration, Topical; Animals; Anti-Infective Agents, Local; Burns; Burns, Chemical; Dermatologic Agents; Guinea Pigs; Male; Mustard Gas; Povidone-Iodine; Protective Agents

Topics: Anti-Infective Agents, Local; Burns; Hot Temperature; Humans; Ointments; Povidone-Iodine; Skin Diseases; Treatment Outcome

The management of burns has shown substantial progress over the years. The application of an effective topical agent improves the healing rate of burns. Betadine cream and ointment have been used in all the burn admissions since 1986. The data collected over 10 years are analysed in this report. All the burn patients admitted were evaluated and the factors investigated included patient age, sex, cause of injury, extent of burn wound, length of hospital stay, bacteriology, multi-organ failure and mortality. A total of 6,056 patients were admitted to a 40-bed unit during the 10-year period. Sixty-two percent were adults and 37% children. There were 67.5% males and 32.5% females. Eighty-one percent were admitted directly to the unit. Intensive/high care admissions accounted for 19.2% patients. The major cause of injury was accidental scalding in 34.2% patients, and the majority (65.4%) stayed between 1 and 4 weeks in hospital. There were 452 deaths. This audit reviewing 6,056 sequential burn cases represents a 10-year experience of burn management, using Betadine cream and ointment as topical agent.

Topics: Accidents; Administration, Cutaneous; Adult; Age Factors; Anti-Infective Agents, Local; Burns; Burns, Chemical; Cause of Death; Child; Child, Preschool; Critical Care; Female; Hospitalization; Humans; Infant; Infant, Newborn; Iodophors; Length of Stay; Male; Medical Audit; Multiple Organ Failure; Ointments; Patient Admission; Povidone-Iodine; Sex Factors; South Africa; Survival Rate; Wound Healing

The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.

Topics: Age Factors; Alginates; Anti-Infective Agents, Local; Bacteremia; Bacteria; Bandages; Biopsy; Body Surface Area; Burns; Cerium; Chlorhexidine; Colony Count, Microbial; Follow-Up Studies; Forecasting; Graft Survival; Humans; Leukocyte Count; Linear Models; Povidone-Iodine; Pseudomonas Infections; Silver Sulfadiazine; Skin Transplantation; Staphylococcal Infections; Treatment Failure; Treatment Outcome; Wound Infection

Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Burns; Child; Drug Combinations; Hand Injuries; Humans; Male; Ointments; Povidone-Iodine; Sucrose

In order to compare the therapeutic value of moist burn ointment (MBO) and betadine ointment in severe burns, the authors divided 30 patients with burn over 30% TBSA into two groups. In one group MBO was used, and in another group betadine was used. The result showed; 1. The difference between two groups was not great in superficial II degree burn wound. 2. MBO was less effective than betadine in deep burn wound. MBO had little antibacterial effect, wound healing was delayed, and incidences of infection, complication and mortality were higher. At the same time, MBO did not have noticeable effect in inhibiting scar hypertrophy. The authors suggest that MBO must be used with caution in severe burn patients, especially in the southern provinces where the climate is hot and humid.

Topics: Administration, Topical; Adult; Animals; Burns; Drugs, Chinese Herbal; Female; Follow-Up Studies; Humans; Ointments; Povidone-Iodine

Electrostimulation of wounds caused healing to proceed in a thoroughly organized manner. A trial using rats subjected to second degree burns was conducted to evaluate, under scanning electron microscopy (SEM), the healing capabilities of skin to which an antiseptic (iodine) and referred electrical stimulation were applied. Untreated, unharmed skin was also studied as control. Images obtained using SEM revealed that only the repaired skin of the electrostimulated group had an appearance similar to that of the control skin (kappa = 1), and that the overall appearance of the repaired skin was compatible with a well organized healing process.

Topics: Animals; Burns; Cicatrix; Electric Stimulation Therapy; Infections; Male; Microscopy, Electron, Scanning; Povidone-Iodine; Rats; Rats, Sprague-Dawley; Wound Healing

In three previous studies the Water-Jel (WJ) system was found to protect burn wounds from microbial contamination, to have excellent analgesic and cooling effects when used as a first-aid dressing and to be bactericidal to 15 microorganisms including yeasts tested from the Ostrava Burn Unit. Now a new WJ system has been introduced without povidone iodine. An extensive bacteriological laboratory evaluation of the new WJ system showed quite clearly its excellent antimicrobial and antimycotic properties for 13 of the 15 strains of microorganisms tested, the only exceptions being Clostridium difficile and partially Streptococcus faecalis. In a preliminary study, the new WJ system was used for 24-48 h in 74 burned patients with superficial partial and deep partial skin thickness burns. In 89 per cent of them there were no signs of infection on their burn wound after 48 h. The new WJ system was well tolerated and no allergic reactions appeared.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Bacterial Infections; Bacteriological Techniques; Burns; Candidiasis; Colony Count, Microbial; Humans; Occlusive Dressings; Povidone-Iodine; Yeasts

Topics: Animals; Anti-Infective Agents, Local; Burns; Ether; Female; Guinea Pigs; Humans; Iodophors; Male; Mice; Microbial Sensitivity Tests; Povidone-Iodine; Rabbits; Staphylococcus aureus

The effect of Betadine solution and cream was examined in the treatment of burn patients (23 documented and about 200 non-documented) during the first six months of 1991. The laboratory examinations did not reveal changes in T3, T4, TSH values. Renal failure due to iodine absorption was not observed. Hypersensitivity to the agent was not recorded. Healing of superficial and deep second-degree burns was especially rapid in some cases. In cases of third-degree burns the wounds remained "dry" until the operation. Favourable effect was also observed in the pretreatment of the donor skin areas. The authors found Betadine to be definitely advantageous in the treatment of burn patients.

Topics: Administration, Topical; Adult; Aged; Bandages; Burns; Combined Modality Therapy; Drug Evaluation; Female; Humans; Injury Severity Score; Male; Middle Aged; Povidone-Iodine; Skin Transplantation; Solutions; Thyroid Hormones; Treatment Outcome; Wound Healing

Survival analysis methods are valuable for detecting intervention effects because detailed information from patient records and sensitive outcome measures are used. The burn unit at a large university hospital replaced routine bathing with total body bathing using chlorhexidine gluconate for antimicrobial effect. A Cox proportional hazards model was used to analyse time from admission until either infection with Staphylococcus aureus or discharge for 155 patients, controlling for burn severity and two time-dependent covariates: days until first wound excision and days until first administration of prophylactic antibiotics. The risk of infection was 55 per cent higher in the historical control group, although not statistically significant. There was also some indication that early wound excision may be important as an infection-control measure for burn patients.

Topics: Anti-Bacterial Agents; Baths; Body Surface Area; Burn Units; Burns; Chlorhexidine; Clinical Protocols; Hospitals, University; Humans; Incidence; Infection Control; Length of Stay; Povidone-Iodine; Proportional Hazards Models; Risk Factors; Staphylococcal Infections; Time Factors; Treatment Outcome

There are frequent reports of the chronic nature of skin ulcers of varying etiology (burns, bedsores, wound diastasis, etc.); these heal with considerable difficulty probably due to problems related to the excessive use of disinfectants which, in spite of having a good bacterial action, interfere with re-epithelialisation processes. The aim of this study was to assess the value of simple wound cleansing instead of disinfection in those cases where there are no manifest signs of bacterial contamination. A widely sold solution, Katoderm (Devergè, Turin), was used in this study. The study was performed in two stages; the first in laboratory animals and the second in patients with small persistent lesions. The results of the study carried out in rats showed a significant prolongation of healing time in the group treated with polyvinylpyrrolidone-iodine compared to those in which lesions were only cleansed with Katoderm. The results of the clinical study also highlighted the faster speed of healing in patients treated with cleansing alone.

Topics: Administration, Topical; Animals; Burns; Detergents; Humans; Povidone-Iodine; Pressure Ulcer; Rats; Skin Ulcer; Wound Healing

Topics: Anti-Infective Agents, Local; Burns; Drug Combinations; Humans; Nitrofurazone; Potassium Iodide; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

A new topical antiseptic agent, 5 per cent polyvinylpyrrolidone-iodine (PVP-I) cream, with altered physicochemical properties, incorporated in a different carrier base has proved in vivo to be more effective in controlling burn wound infections than 10 per cent PVP-I ointment. Important biodynamic properties of the new formulation have not, however, been elucidated in vivo. Hence the need for a controlled study to evaluate the bioavailability of the active component after penetration through burn eschar; the bactericidal efficacy of the cream and determination of the bactericidal time of the cream in comparison with 10 per cent PVP-I ointment. A modified Walker burn wound model was used to define the rate of trans-eschar penetration, biodynamic availability and bactericidal efficacy of 5 per cent povidone iodine cream in established Pseudomonas aeruginosa burn wound infection. In vitro penetration confirmed the effective diffusion of PVP-I cream through 1.5 mm eschar within 6 h. A single topical application of PVP-I cream resulted in a 98.8 per cent (6.088 x 10(9) c.f.u./g of tissue to 7.367 x 10(7) c.f.u./g of tissue) reduction in intra-eschar viable organisms within 18 h after application. A second topical application of PVP-I cream at 18 h resulted in a total reduction of 99.8 per cent in viable organisms (2.90 x 10(9) c.f.u./g of tissue to 7.009 x 10(6) c.f.u./g of tissue) within 48 h. Comparing the in vitro bactericidal time of povidone iodine ointment with cream against Pseudomonas aeruginosa, Staphylococcus aureus and a Klebsiella pneumoniae revealed that the PVP-I cream killed organisms ten-fold more quickly than the ointment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Animals; Biological Availability; Burns; Emollients; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Rats

Standardized burns without experimental infection and such with infection by a constant number of bacteria of a fixed Pseudomonas-aeruginosa-strain were treated differently. Silver sulfadiazine- and Cefsulodin-cream, Polyvidon-iodine-ointment (PVP-Jod), and hyperbaric oxygen (OHP) were used to them. The courses of healing were checked by determination of the wound area daily. The best results showed the experimental uninfected untreated wounds. Wounds infected by Pseudomonas were healing most quickly by immediate and continuous application of hyperbaric oxygen. By silver sulfadiazine- and Cefsulodin-cream treated burns showed statistical significant better results than the control group. The courses of healing were significantly poorer in delayed application of OHP (only from the 8th day after the burn) or in case of therapy with PVP-iodine alone.

Topics: Administration, Topical; Animals; Burns; Cefsulodin; Female; Guinea Pigs; Hyperbaric Oxygenation; Ointments; Povidone-Iodine; Pseudomonas Infections; Silver Sulfadiazine; Wound Healing; Wound Infection

In this report the possibilities for the application of PVP-iodine-preparations in the developing countries in the treatment of wounds, including burns and in diseases of the mucous membrane, eyes, mouth and genital region are discussed. The application proved particularly valuable where a high antibiotic resistance was found.

Topics: Atlantic Islands; Burns; Chemical Phenomena; Chemistry; Eye Diseases; Humans; Povidone; Povidone-Iodine; Skin Diseases, Infectious; Sudan; Surgical Wound Infection; Wound Infection; Wounds and Injuries

In an open comparative study, 40 patients suffering from pyoderma, combustion (1st and 2nd degrees), leg ulcer, or inflammatory white atrophy were treated with a topical preparation containing either polyvinyl pyrrolidone iodine or neomycin. Both preparations were well-tolerated. There was no local hypersensibility. With regard to the therapeutic effect, we did not observe any differences between the two groups of patients. We discuss the properties, modes of action, and contraindications, as well as the possible systemic influences of topically applied PVP iodine.

Topics: Administration, Topical; Adolescent; Adult; Aged; Atrophy; Burns; Female; Humans; Male; Middle Aged; Neomycin; Povidone; Povidone-Iodine; Pyoderma; Skin; Skin Diseases, Infectious; Varicose Ulcer; Wound Infection

Hyperthyroidism was induced in two burn patients (one a 34-year-old male, with burns covering 80 per cent BSA and the other a 22-year-old female with a 45 per cent BSA burn) by topical treatment with povidone-iodine. Both patients had no history of thyroid disease and their post-burn examination revealed normal thyroid glands. In both patients 1 per cent povidone-iodine was applied onto granulation tissue and a marked increase in circulating thyroid hormones occurred. After topical treatment with povidone-iodine was discontinued circulating thyroid hormones returned to normal values within weeks. In the second patient povidone-iodine treatment had to be repeated again resulting in hyperthyroidism which was also readily reversible.

Topics: Administration, Topical; Adult; Burns; Female; Humans; Hyperthyroidism; Male; Methimazole; Povidone; Povidone-Iodine; Thyroid Hormones

This study has shown that Betadine cream with or without Aserbine is as easy to apply and remove as Betadine ointment plus Aserbine. With Betadine cream there is as good as and in some instances better healing than with Betadine ointment/Aserbine in the topical treatment of burns. However, the addition of a necrolytic cream to Betadine cream does have favourable effects on wound healing and bacterial counts. More importantly, this study suggests that Betadine cream can penetrate the wound more effectively than the Betadine ointment/Aserbine combination but that the addition of a necrolytic cream is still advantageous.

Topics: Administration, Topical; Adolescent; Adult; Aged; Benzoates; Burns; Child; Child, Preschool; Drug Combinations; Humans; Infant; Malates; Middle Aged; Ointments; Povidone; Povidone-Iodine; Salicylates; Wound Healing; Wound Infection

Topics: Burns; Humans; Povidone; Povidone-Iodine

Topics: Burns; Humans; Ointments; Povidone; Povidone-Iodine

A remarkable improvement in the rate of burn healing has been achieved with a mixture of povidone-iodine ointment (Betadine) and malic, benzoic and salicylic acids (MBS) (Aserbine). A study was undertaken to compare the effects of a new povidone-iodine formulation (Betadine cream) with and without MBS with povidone-iodine ointment plus MBS. All preparations were easy to apply and were readily removed, causing only mild discomfort on application in the majority of cases. A significant difference in healing times was observed between povidone-iodine cream and povidone-iodine cream plus MBS. There was also a significant difference in the decrease in the number of positive bacterial cultures between these two treatments. This applied to both superficial and deep burns. No skin sensitivity reactions were reported with any of the preparations. The addition of MBS to povidone-iodine cream did not produce as significant an improvement in results as its addition to povidone-iodine ointment.

Topics: Administration, Topical; Adolescent; Adult; Anti-Infective Agents, Local; Benzoates; Burns; Drug Combinations; Humans; Malates; Ointments; Povidone; Povidone-Iodine; Salicylates; Time Factors; Wound Healing; Wound Infection

Average iodine serum levels of 2.5 mg/100 ml were obtained in 10 patients with an average burn area of 50% and treated with povidone-iodine. Simultaneous measurements of the thyroid hormones failed to reveal any significant impairment of thyroid function apart from depressed T3 coupled with increased reverse T3. Similar findings were obtained with a control group of 10 multiply-injured patients. If renal function is unimpaired the resorbed iodine is quickly excreted. No clinical signs of iodine intoxication were observed.

Topics: Anti-Infective Agents, Local; Burns; Humans; Iodine; Povidone; Povidone-Iodine; Thyroid Hormones; Thyroxine; Triiodothyronine

The improvement in infusion therapy of burn patients in the last decades has led to a marked reduction of the early mortality rate and to an increase in the importance of severe wound infection and septicaemia. For the control of infection, detailed bacteriological monitoring is recommended. The main therapeutic fields for prevention of infection are: immunotherapy, antisepsis, aseptic techniques, and rapid restoration of the destroyed body surface. The most important part of antisepsis in burns is topical treatment. The good bacteriological and clinical results with povidone-iodine (PVP-I), in combination with open treatment are described. A possible disadvantage of this therapy was the extensive iodine resorption. However, no disorders of thyroid function were revealed, and the TRH test indicated no abnormal reactions of the hypothalamus-pituitary axis. The high serum and urine iodine levels returned rapidly to normal after discontinuing the PVP-I application.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacterial Infections; Burns; Humans; Hypothyroidism; Iodine; Middle Aged; Povidone; Povidone-Iodine; Silver Sulfadiazine; Time Factors

Topics: Administration, Topical; Anti-Bacterial Agents; Burns; Chlorhexidine; Gentamicins; Humans; Kinetics; Mafenide; Polymyxins; Povidone-Iodine; Pseudomonas Infections; Silver Nitrate; Silver Sulfadiazine; Staphylococcal Infections; Streptococcal Infections; Wound Infection

Concentrations of iodine were assayed in burn patients, who were covered with Iodoplex ointment up to 30% of their body surface. The iodine levels in the serum were found to be in linear proportion to the area treated with an increase of 30 micrograms iodine per 100 ml of serum for 1% of TBSA. The maximal levels were reached within 24 hours of applying the Iodoplex ointment and decreased quickly following its discontinuation. Concentrations of the iodine were much lower than those found after treatment with povidone iodine, a fact which indicates that using Iodoplex in second-degree burns and donor sites entails fewer possible complications due to high levels of iodine in the serum than with povidone iodine.

Topics: Acrylic Resins; Adult; Anti-Infective Agents; Burns; Drug Evaluation; Humans; Iodine; Male; Ointments; Povidone; Povidone-Iodine; Skin Absorption

Under exposure treatment of 33 burn patients with povidone-iodine (polyvinylpyrrolidon-iodine) preparations (Betaisodona ointment and solution) massive absorption of the iodine by the body and temporary changes in the thyroid hormones (T3 and T4 lowered, TSH raised) were found. No other clinical or laboratory-chemical side effects were observed in the patients. TRH stimulation test was carried out on 18 patients 3-6 months after ceasing povidone-iodine application. The results showed normoreaction of the hypothalamus-pituitary regulation. Povidone-iodine topical treatment of the burn patients involves them in substantial exposure to iodine, but offers no additional risk to the patients.

Topics: Administration, Topical; Adolescent; Adult; Burns; Humans; Iodine; Middle Aged; Povidone; Povidone-Iodine; Thyrotropin; Thyroxine; Triiodothyronine

By uncontrolled application without indication of a photoactive drug methoxypsoralen (Meladinine) which is sold only on prescription a 20-year-old man sustained a large burn injury of 71% of body surface. Because he was admitted to the hospital relatively late, a life-threatening condition developed as it is well known after large body burns. Adequate intensive care including artificial respiration and proper local treatment to prevent infection were decisive for successful treatment.

Topics: Adult; Burns; Combined Modality Therapy; Critical Care; Humans; Male; Methoxsalen; Povidone-Iodine; Respiration, Artificial; Self Medication; Shock; Ultraviolet Rays

Topics: Bacterial Infections; Baths; Burns; Humans; Iodine; Iodophors; Occlusive Dressings; Povidone; Povidone-Iodine; Wound Healing; Wound Infection

Topics: Acidosis; Administration, Topical; Burns; Humans; Hydrogen-Ion Concentration; Povidone; Povidone-Iodine

The serum concentrations of thyroxine (T4), triiodothyronine (T3) and TSH as well as the effective thyroxine ratio (ETR) and the resin-T3-uptake (RT3U) were studied in 23 severely burned patients during the whole time of hospitalisation. Topical treatment was carried out with povidone-iodine. In all patients T4 and T3 concentrations decreased significantly during the first two weeks especially in extensive burns. Lack of increase was a bad prognostic sign. ETR and RT3U underwent no remarkable changes. The TSH levels increased distinctively until the third week, decreased slowly and turned to normal values only in the late period of illness. The influence of iodine uptake due to external application is discussed.

Topics: Administration, Topical; Adolescent; Adult; Aged; Burns; Child; Humans; Middle Aged; Povidone; Povidone-Iodine; Thyroid Hormones; Thyrotropin; Thyroxine; Triiodothyronine

We have confirmed the generation of suppressor cells as the result of lymphocyte exposure to Betadine, a topical bacteriocide in common clinical use. Suppressor cell induction is the result of cell surface changes which we found to be completely reversible by the action of the reducing agent, sodium borohydride. These findings are important clinically, particularly as they relate to burn patients who often accumulate iodine concentrations sufficient to depress immune responsiveness. Our results suggest that suppressor cell development resulting from Betadine treatment is reversible. Experimental burn treatment procedures could easily be modified to include procedures to abolish such suppressor cell activity.

Topics: Borohydrides; Burns; Humans; Lymphocyte Activation; Povidone; Povidone-Iodine; T-Lymphocytes, Regulatory

Topics: Adolescent; Adult; Burns; Child; Female; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Thyroid Function Tests; Thyroid Hormones

Topics: Administration, Topical; Anti-Bacterial Agents; Burns; Candidiasis; Gentamicins; Humans; Mafenide; Pain; Povidone-Iodine; Pruritus; Silver Sulfadiazine; Skin Ulcer; Vitamins; Wound Infection

Markedly elevated serum PBI levels occur after therapy with povidone-iodine (Betadine), an iodine-polyvinylpyrrolidone iodophor. In this study, we investigated the serum iodine compounds from a severely burned patient with normal initial thyroid function tests who was swabbed with Betadine ointment and received daily therapeutic baths in Betadine. Three and 9 days after therapy, his serum contained 93 and 168 micrograms PGI/dl, respectively (normal range, 4-8), while the serum T4 and free T4 index were normal; the serum T3 level, however, was abnormally depressed. Most of the PBI was in albumin, and hydrolysis of the serum proteins with proteases released 35% of the PBI as monoiodotyrosine, 3.2% as diiodotyrosine, 0.01% as T3, and 2.5% as T4, as determined by competitive radioassays, anion exchange, and reversed phase high pressure liquid chromatography. The same concentrations of T4 and T3 were detected before and after hydrolysis. Failure of the proteases to completely hydrolyze iodoalbumin partially explains why all of the PBI was not recovered as iodotyrosines in the serum protein hydrolysates. Povidone-iodine rapidly iodinated tyrosine residues in human serum albumin at pH 7.4 and 37 C in vitro, and the ratio of diiodotyrosine to monoiodotyrosine increased as the molar ratio of povidone-iodine to albumin was increased. It is concluded that the abnormal increase in serum PBI resulted from absorption of the iodophor into the blood where it primarily iodinated albumin and, to a lesser extent, the globulins.

Topics: Administration, Topical; Blood Proteins; Burns; Humans; Iodine; Kinetics; Male; Middle Aged; Monoiodotyrosine; Povidone; Povidone-Iodine; Thyroid Function Tests; Thyroxine; Triiodothyronine

Topics: Adult; Burns; Female; Humans; Iodine; Lymphocyte Culture Test, Mixed; Male; Middle Aged; Phytohemagglutinins; Povidone; Povidone-Iodine; T-Lymphocytes, Regulatory

This presentation reviews the course of burn wound sepsis in a group of 621 acute patients treated at the Shriners Burns Institute, Cincinnati Unit, between 1970 and 1976. During this period of time, the overall mortality rate fell from 14% in 1970 to 3 and 5%, respectively, in 1975 and 1976. Staphylococcus aureus was the most commonly recovered organism from the burn wound, colonizing 85% of the burn patients. Beta hemolytic streptococcus represented a potential threat despite the fact that it was recovered from only 5 to 10% of the patients. Pseudomonas aeruginosa showed a decrease in colonization during the period of this study, from 50% of the wounds in 1970 to 21% in 1976. Candida albicans was the fungal organism most commonly recovered from the burn wound and from the blood stream. Fifteen deaths occurred in this group as a result of invasive infection, one from S. aureus, five from P. aeruginosa, two from Klebsiella-Enterobacter, and one from Escherichia coli, as well as six fungal deaths, five from Candida albicans and one from mucormycosis. Therapeutic measures used to control burn wound sepsis consisted of prevention of contamination from exogenous sources, control of burn wound pathogens, early recognition of invasive burn wound sepsis, aggressive management of the burn wound, and optimal nutritional support. During this period the extent of burn associated with a survival of 50% has risen from 50% in 1970 to 80% in 1976. This improvement in survival is directly related to progressive improvement in local and systemic measures available for the control of infection.

Topics: Burns; Gentamicins; Humans; Mafenide; Nitrofurazone; Povidone-Iodine; Sepsis; Silver Nitrate; Silver Sulfadiazine; Wound Infection

The bacteriocidal effect of three substances is discussed: 10% povidone iodine ointment (Betadine, betaisodona), 11,2% mafenide acetate (Naplatan) and silver sulphadiazine (Flamazine, Silvadene, Silvertone). A modified Walker burn model using male Long-Evans rats was studied. The infections were produced with a solution of 3 times 10(8) Pseudomonas aeruginosa pyocin type H. organisms. The authors described the pharmacological properties of the three substances and report the following results. All three substances are able to penetrate third degree burns. It takes 4 hours for povidone iodone, 12 for mafenide acetate and 24 for silver sulphadiazine to penetrate the burn. Mafenide acetate and silver sulphadiazine were the most useful agents after 12 and 24 hours respectively. When the substances were applied for a second time 24 hours after the first application only mafenide acetate was highly effective. The effectiveness of povidone iodine and silver sulphadiazine decreased by half when compared with the first application. For practical purposes the following recommendations are made: For deep burns povidone iodine should be applied every 4--6 hours, mafenide acetate every 12--18 hours and silver sulphadiazine once every 24 hours in order to ensure an antibacterial effect.

Topics: Administration, Topical; Animals; Burns; Disease Models, Animal; Mafenide; Male; Povidone; Povidone-Iodine; Pseudomonas Infections; Rats; Silver Sulfadiazine; Sulfadiazine; Sulfonamides; Time Factors; Wound Infection

Over a 56-month period (January 1976 to August 1980), we treated 605 patients for wounds, burns, and ulcers with granulated sugar and povidone-iodine. Rapid healing ensued, due to a reduction in bacterial contamination, rapid debridement of eschar, probable nourishment of surface cells, filling of defects with granulation tissue, and covering of granulation tissue with epithelium. The requirements for skin grafting and antibiotics were greatly reduced, as were hospital costs for wound, burn, and ulcer care.

Topics: Adolescent; Adult; Aged; Burns; Drug Combinations; Female; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Sucrose; Ulcer; Wound Healing; Wounds and Injuries

The influence of topical antimicrobial agents on bacterial growth was determined with an agar diffusion technique. 349 isolates were tested with mafenide acetate and silver sulfadiazine, 226 isolates were tested with povidone iodine. None of these agents was likewise effective against all organisms of the same bacterial strain. The inhibition of growth by mafenide acetate and silver sulfadiazine demonstrated dose-response. 26 to 40% of the tested grampositive cocci were inhibited by mafenide acetate, whereas the growth of about 26 to 90% of gramnegative rods was effected by silver sulfadiazine, with the exception of proteus species (9%). Both agents influenced the growth of pseudomonas (40 to 65%). The results obtained with povidone iodine led to the consideration that the agar diffusion method might not be suitable for testing this drug.

Topics: Anti-Bacterial Agents; Bacteria; Burns; Enterococcus faecalis; Escherichia coli; In Vitro Techniques; Mafenide; Ointments; Povidone-Iodine; Pseudomonas aeruginosa; Silver Sulfadiazine; Staphylococcus aureus

Povidone-iodine ointment is a widely used topical antimicrobial agent in thermally injured patients. In 17 patients with burns ranging from 4 to 85% TBSA this agent was applied to both partial- and full-thickness burns. Peak serum iodine levels in patients treated within 24 hours of injury ranged from 595 to 4,900 micrograms per dL. The amount of iodine absorbed was directly related to the size of the burn. Serum iodine levels continued to rise until the drug was discontinued and remained elevated for as long as 7 days after discontinuance. Iodine excretion was directly related to renal function. The highest serum and lowest urinary iodine levels were present in patients who developed renal failure. Thyroid function was not affected by drug usage. A proven cause-and-effect relationship between the elevated serum iodine attributed to the absorption of povidone-iodine and metabolic acidosis, hypernatremia, and hyperosmolarity was not established. Close monitoring of the patient's fluid and electrolyte balance is imperative during drug usage. The drug is contraindicated in any patient with impaired renal function. The high serum levels of this inorganic ion imply potential toxicity, but clinical evidence of cell or organ toxicity is as yet undetermined.

Topics: Absorption; Acute Kidney Injury; Body Surface Area; Burns; Humans; Iodine; Povidone; Povidone-Iodine; Tissue Distribution

Those factors that have contributed most to the control of burn wound sepsis in the burn patient since 1930 have been the advent of penicillin, the institution of burn center care, the availability of aminoglycosides and antifungal agents, the advent of topical therapy, the aggressive treatment of the burn wound by excisional therapy, a better understanding of respiratory therapy, the support of immune competence, and the recognition of the importance of nutritional support (Fig. 1). At the Shriners Cincinnati Unit, the extent of burn associated with a survival rate of 50 per cent has risen from 70 per cent in 1970 to 80 per cent in 1978. The better chance of survival for burn patients during this period can be directly related to a progressive improvement in the local and systemic measures available for the control of infection.

Topics: Burns; Gentamicins; Humans; Mafenide; Nitrofurazone; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine; Wound Infection

Topics: Adult; Agranulocytosis; Anti-Bacterial Agents; Burns; Humans; Iodine; Male; Neutropenia; Povidone; Povidone-Iodine; Sepsis

Topics: Administration, Topical; Bacterial Infections; Burns; Humans; Povidone; Povidone-Iodine; Wound Infection

The goal in the treatment of septic burn wounds, as in any infection, is to reestablish the normal balance between the bacteria and the host defense. This is readily done by controlling the numerical level of bacteria while expending all efforts to remove irreversibly damaged tissue and obtaining a closed wound by autograft with the patient's own skin as rapidly as possible.

Topics: Burns; Gentamicins; Humans; Mafenide; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine; Wound Infection

Topics: Anti-Infective Agents, Local; Burns; Humans; Povidone; Povidone-Iodine; Skin Ulcer; Surgical Wound Infection; Wounds and Injuries

Topics: Burns; Dermatologic Agents; Humans; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine; Sodium Hypochlorite

A planned treatment program for burned hands has been developed and was used in 72 burns of the dorsum of the hands. Treatment was individualized on the basis of whether hand burns were superficial or deep. In the former, there was evidence of spontaneous reepithelialization within 14 to 21 days. In the latter, immediate or delayed excision, followed by resurfacing with autografts was done. Both groups received topical antibiotic creaming, elevation, an exercise program as soon as they were able, and splinting of the burned hand in the antideformity position. Hypertrophic scars and unacceptable epithelium were excised when they interfered with function. Initially, this program allowed us to avoid unnecessary surgical procedures in 94% of the second-degree burns of the dorsum of the hand. The third-degree burned hand needed excision and autografting in 100% of the burned hands. This treatment program has as its goals: prevention of deformity by early motion and protection of the unburned and regenerating epithelium by creaming with topical antibiotic ointment.

Topics: Burns; Exercise Therapy; Female; Hand Injuries; Humans; Male; Povidone-Iodine; Skin Transplantation; Splints; Transplantation, Autologous; Wound Healing

Topics: Burns; Humans; Povidone; Povidone-Iodine

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Bacterial Infections; Burns; Cerium; Gentamicins; Humans; Mafenide; Nitrates; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine

Topics: Acidosis; Administration, Topical; Adult; Burns; Female; Humans; Hypernatremia; Povidone; Povidone-Iodine

Topics: Adolescent; Adult; Aged; Burns; Child; Child, Preschool; Humans; Infant; Middle Aged; Ointments; Povidone; Povidone-Iodine; Wound Infection

Nitrofurazone (N), povidone-iodine (P), and silver sulfadiazine (S) were compared in the emergency department outpatient treatment of 84 patients suffering second degree burns over less than 15% (adults) or 5% (children) of their total body surface area. Indices of healing were percent of healing, degree of dryness, crust separation, eschar separation, tissue granulation, and wound pain. Statistical analysis indicates that healing in N-treated patients was superior to that in S-treated patients: tissue granulation began sooner, crusts separated more rapidly, wounds were dryer, and the amount of healing at two weeks was greater. Results in P-treated patients were equivalent to those in N-treated when cases with complications were excluded from analysis. Among patients with less serious burns, N-treated patients suffered less pain than S-treated, but there was no significant difference in pain between N and P or between P and S. In patients with more serious second-degree burns there was more pain with P than with N, but neither P nor N differed significantly from S in this regard.

Topics: Burns; Drug Evaluation; Humans; Nitrofurazone; Povidone; Povidone-Iodine; Silver Sulfadiazine; Sulfadiazine; Wound Healing

The overwhelming majority of burns are minor and can be treated on an ambulatory basis if hospitalization is not indicated. Recommended are topical antimicrobial agents in the acute phase and pressure garments after wound healing. Sound principles of burn wound management determine the ultimate outcome of treatment, the degree of function and the cosmetic appearance of the healed wound.

Topics: Administration, Topical; Ambulatory Care; Anti-Infective Agents; Burns; Humans; Mafenide; Nitrofurazone; Occlusive Dressings; Ointments; Povidone-Iodine; Silver Sulfadiazine; Tetanus

One of the dangers of topical therapy in thermal injuries is absorption of the therapeutic agent with subsequent metabolic and toxic complications. Two patients, one 30 years old with a 75% burn, the second 72 years old with a 35% burn, were treated topically with povidone-iodine ("Betadine", pH 2.43). In both patients severe metabolic acidosis developed which could not be attributed to sepsis, hypovolaemia, renal failure, diabetes, lactic acidaemia, &c. The acidosis associated with the 75% burn required large amounts of sodium bicarbonate to maintain pH at 7.35 and a serum-bicarbonate concentration of 15 mmol/l (meq/l); serum-iodine was 48000 mug/dl (normal 4-8.5mug/dl). Acidosis in the second patient was not as severe, and serum-iodine concentration reached 17600 mug/dl. The rate of urinary excretion of iodine was 50.8 +/- 7.4 mg/dl and seemed to be fixed. Haemodialysis was very effective in reducing serum-iodine concentration. Povidone was also systemically absorbed. The persistent acidosis could be caused by absorption of the iodine or the acidic povidone-iodine. Until the aetiology of the acidosis and renal damage is more clear, iodophors should not be used topically for burns greater than 20% of the body surface or in the presence of renal failure.

Topics: Absorption; Acid-Base Imbalance; Acidosis; Administration, Topical; Adult; Aged; Bicarbonates; Burns; Creatinine; Female; Humans; Iodine; Kidney; Male; Povidone; Povidone-Iodine; Renal Dialysis; Sodium

Topics: Blood Urea Nitrogen; Body Surface Area; Burns; Creatinine; Humans; Kidney; Povidone; Povidone-Iodine; Time Factors

Topics: Acidosis; Burns; Humans; Povidone; Povidone-Iodine

The ability of topical antiseptics to penetrate eschar of burn patients was determined by the agar diffusion technique. Gentamicin sulfate, mafenide acetate, nitrofurazone, povidone-iodine, silver nitrate, and silver sulfadiazine were tested against clinical isolates of Candida albicans, Staphylococcus, Streptococcus, and gram-negative bacilli including Pseudomonas aeruginosa. In practically all instances, the diameters of the zones of inhibition observed using eschar were comparable to those obtained with filter-paper discs. This finding showed that the antimicrobial agents could penetrate eschar and retain their effectiveness after penetration.

Topics: Anti-Infective Agents, Local; Bacterial Infections; Burns; Candidiasis; Gentamicins; Humans; In Vitro Techniques; Mafenide; Nitrofurazone; Povidone-Iodine; Silver Nitrate; Sulfadiazine; Wound Infection

Providone-iodine is used as a topical antimicrobial in burn patients. Although absorption of iodine has been thought to be negligible, several patients have recently been noted with substantial elevations of serum free iodide. Unexplained abnormalities occurred in several of these patients, renal failure, metabolic acidosis, and elevation of serum glutamic oxaloacetic transaminase. It is conceivable that the large iodide loads noted were at least in part responsible for these abnormalities.

Topics: Acid-Base Equilibrium; Acidosis; Administration, Topical; Adolescent; Adult; Aspartate Aminotransferases; Burns; Carbon Dioxide; Female; Humans; Hydrogen-Ion Concentration; Infant; Iodides; Iodine; Kidney; Male; Middle Aged; Peritoneal Dialysis; Povidone; Povidone-Iodine; Time Factors

The pathophysiology, classification and bacteriology of burns are discussed, as well as treatment of burns with silver nitrate, silver sulfadizine, silver allantoinate, mafenide acetate, furazolium chloride, povidone-iodine complex, antibiotics, antiproteolytics, fibrinolytics, Pseudomonas vaccine and antiglobulins.

Topics: Administration, Topical; Allantoin; Anti-Bacterial Agents; Antibodies, Anti-Idiotypic; Burns; Enzyme Inhibitors; Fibrinolytic Agents; Humans; Immunotherapy; Mefenamic Acid; Nitrofurans; Povidone-Iodine; Protease Inhibitors; Pseudomonas; Quaternary Ammonium Compounds; Silver Nitrate; Sulfadiazine; Thiazoles; Wound Infection

Topics: Bacteria; Burns; Cross Infection; Escherichia coli; Escherichia coli Infections; Evaluation Studies as Topic; Gastroenteritis; Hand; Hexachlorophene; Humans; Hygiene; Infant Care; Intensive Care Units; Medical Staff, Hospital; Methods; Nurseries, Hospital; Nursing Staff, Hospital; Povidone-Iodine; Pseudomonas aeruginosa; Skin; Soaps; Staphylococcus; Streptococcus

Topics: Abdomen; Arm; Back; Burns; Buttocks; Child; Debridement; Humans; Leg; Nitrofurazone; Organ Specificity; Povidone-Iodine; Scalp; Skin Transplantation; Sulfadiazine; Time Factors; Transplantation, Homologous; Wound Healing

Topics: Burns; Humans; Povidone; Povidone-Iodine; Wound Infection

Topics: Administration, Topical; Adolescent; Adult; Aged; Burns; Candidiasis; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Infection Control; Klebsiella Infections; Male; Middle Aged; Ointments; Povidone; Povidone-Iodine; Proteus Infections; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Adolescent; Adult; Aerosols; Aged; Ambulatory Care; Bandages; Burns; Child; Child, Preschool; Furazolidone; Humans; Infant; Middle Aged; Povidone; Povidone-Iodine; Time Factors; Wound Healing

Topics: Burns; Humans; Povidone; Povidone-Iodine; Preoperative Care; Surgical Wound Infection; Wounds and Injuries

Topics: Anti-Infective Agents, Local; Burns; Drug Therapy; Halogens; Humans; Hydrocarbons, Halogenated; Povidone-Iodine; Skin Diseases; Wounds and Injuries

Topics: Aerosols; Anti-Infective Agents; Anti-Infective Agents, Local; Biomedical Research; Burns; Hexachlorophene; Humans; Infections; Iodine; Povidone; Povidone-Iodine; Skin Ulcer; Solutions; Surgical Procedures, Operative; Surgical Wound Infection

For purposes of comparison with the occlusive dressing method of treating burns, the exposure method was used in 30 cases-16 of first and second degree and 14 of third degree. Attempt was made to simulate the conditions which might be expected to prevail in mass treatment of burned patients-inadequate personnel and materials. Elaborate measures to immobilize burned areas were not employed. Healing of first and second degree burns was natural and the results satisfactory without further treatment. In third degree burns, skin grafting was necessary after the eschar was removed. Cracking of the eschar several days before time to remove it in some cases of third degree burns necessitated use of occlusive dressings in the last few days before skin grafting was done.The exposure method is considered valuable in circumstances in which saving of time, material and personnel is indicated. Generally it is not suitable for treatment of encircling burns of the trunk or extremities, since maintaining the integrity of the eschar is extremely difficult in such situations.

Topics: Behavior Therapy; Burns; Extremities; Female; Humans; Immobilization; Maintenance; Male; Occlusive Dressings; Orthopedic Equipment; Povidone-Iodine; Skin; Skin Transplantation; Torso; Transplants; Treatment Outcome; Wound Healing