povidone-iodine and Conjunctivitis--Bacterial

Ocular infections can have devastating consequences and may lead to blindness. Povidone-iodine (PVP-I) has many potential advantages over the currently used drugs, including a broader antibacterial spectrum, it turns the surface of the eye brown for a few minutes, bacterial resistance has not been seen and it is cheaper than other agents. PVP-I has made a significant contribution to pre- and postoperative ocular surgical prophylaxis, ophthalmia neonatorum prophylaxis and treatment of bacterial conjunctivitis. Scientific support for these applications includes studies conducted over the past 17 years, which are reviewed.

Topics: Adult; Anti-Infective Agents, Local; Conjunctivitis, Bacterial; Eye; Humans; Infant, Newborn; Ophthalmia Neonatorum; Postoperative Care; Povidone-Iodine; Preoperative Care

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

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

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

To evaluate the effectiveness of 2.5% povidone-iodine eye drops (PIED) compared with ophthalmic chloramphenicol (OC) for preventing neonatal conjunctivitis.. 2004 neonates were enrolled from three rural hospitals in a trachoma endemic area. They were randomly assigned to receive either PIED (n = 1024) or OC (n = 974). Infectious conjunctivitis was confirmed by laboratory methods, including specific search for Chlamydia trachomatis by polymerase chain reaction assay.. During the first 48 hours after birth, PIED and OC had similar efficacy against bacterial conjunctivitis (95% confidence interval (CI), -0.031 to -0.004; p = 0.01); from day 3 to day 15, PIED was 6% less effective than OC (95% CI, -0.058 to -0.006; p = 0.01); after day 16 there was no significant difference between the groups (95% CI, -0.022 to 0.041; p = 0.57). However, the risk of C trachomatis conjunctivitis was increased in neonates receiving PIED prophylaxis (relative risk = 1.99 (95% CI, 1.07 to 3.71), log-rank p = 0.029). Ocular side effects were rare and self limiting in both groups (p = 0.223).. PIED seems to increase the risk of acquiring chlamydial conjunctivitis in neonates. Additional measures are required to prevent mother to fetus transmission of chlamydial infection during pregnancy, delivery, and after birth.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlamydia trachomatis; Chloramphenicol; Conjunctivitis, Bacterial; Endemic Diseases; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Mexico; Ophthalmic Solutions; Povidone-Iodine; Trachoma; Treatment Outcome

To report the efficacy of povidone-iodine as a treatment for conjunctivitis in pediatric patients.. Double-masked, controlled, prospective clinical trial.. In an ophthalmology clinic in a general hospital in Manila, Philippines, 459 children (mean [SD] age 6.6 [6.6] years; range, 7 months-21 years) with acute conjunctivitis were studied. Infected eyes were cultured for bacteria and underwent immunofluorescent testing for Chlamydia trachomatis. Viral conjunctivitis was diagnosed if bacterial cultures were negative and diagnostic criteria were met. Subjects were alternated to receive povidone-iodine 1.25% or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop 4 times daily in the affected eye. Ocular inflammation was evaluated daily by the family or patient and weekly by an ophthalmologist. The main outcome measures were days until cured and proportion cured after 1 and 2 weeks of treatment.. Despite adequate statistical power (power >80% for a 1-day difference and P <.05), there was no significant difference between treatment groups regarding the number of days to cure or proportion cured at 1 or 2 weeks whether caused by bacteria or virus (P =.133-.824 for the four comparisons). After 1 week of treatment, povidone-iodine cured marginally more chlamydial infections than the antibiotic (P =.057). By 2 weeks, fewer chlamydial infections were cured than those of viral or bacterial etiology (P =.0001). The younger the patient, the faster their conjunctivitis resolved (R = 0.13, P =.013).. Povidone-iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis, somewhat more effective against chlamydia, and as ineffective against viral conjunctivitis. Povidone-iodine ophthalmic solution should be strongly considered as treatment for bacterial and chlamydial conjunctivitis, especially in developing countries where topical antibiotics are often unavailable or costly.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Child; Child, Preschool; Conjunctiva; Conjunctivitis, Bacterial; Conjunctivitis, Viral; Double-Blind Method; Drug Therapy, Combination; Female; Gramicidin; Humans; Infant; Male; Neomycin; Ophthalmic Solutions; Polymyxin B; Povidone-Iodine; Prospective Studies; Treatment Outcome; Viruses

Giant fornix syndrome (GFS) results in chronic, relapsing conjunctivitis in elderly patients with enophthalmos and enlarged fornices, in which infectious material collects and perpetuates inflammation. A 98-year-old woman presented with persistent, bilateral, purulent conjunctivitis; corneal epithelial defects and progressive blepharospasm that did not respond to artificial tears, topical antibiotics and steroids and amniotic membrane grafts. Additional findings of deep-set orbits with enlarged upper fornices were diagnostic of GFS. Over the next 2 months, she responded to a combination of topical and systemic antibiotics, autologous serum eye drops, povidone-iodine forniceal rinses, and hypochlorous acid treatment of the eyelashes. GFS is an important diagnostic consideration in elderly patients with chronic conjunctivitis and deep-set orbits.

Topics: Aged; Aged, 80 and over; Conjunctival Diseases; Conjunctivitis; Conjunctivitis, Bacterial; Female; Humans; Lubricant Eye Drops; Povidone-Iodine; Staphylococcal Infections

Topics: Conjunctivitis, Bacterial; Conjunctivitis, Viral; Dexamethasone; Humans; Povidone-Iodine; Prospective Studies

Topics: Conjunctivitis, Bacterial; Conjunctivitis, Viral; Dexamethasone; Humans; Povidone-Iodine; Prospective Studies

Giant fornix syndrome (GFS) was first described as a cause for a relapsing mucopurulent conjunctivitis. Predominantly elderly patients have enlarged superior fornices from superior aponeurosis dehiscence that permits the accumulation of protein coagulum that is colonised by bacteria. Established treatment includes the use of intensive topical antibiotic and corticosteroid. We describe a case of a 98-year-old woman with GFS who did not respond to several weeks of intensive (two hourly) treatment with topical prednisolone 1% drops and chloramphenicol. Subsequent additional regular sweeping of the fornices with cotton buds and topical medication did not improve her symptoms but which resolved with manual coagulum debridement and application of 10% povidone-iodine. This treatment offers an effective treatment option of GFS cases, which do not respond to intensive topical corticosteroids and chloramphenicol.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Conjunctivitis, Bacterial; Debridement; Diagnosis, Differential; Drug Administration Schedule; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Ophthalmic Solutions; Povidone-Iodine; Staphylococcal Infections

Investigations were carried out in Cairo's waste disposal sites of the inhabitants of all age groups. Germ-spectrum was analyzed before and after PVP-Iodine-treatment. However, any further dilution of PVP-Iodine in the treatment had no effect on the germspectrum, as hydrochloric acid formation in air, produced by plastic burning causes severe eye irritation and a constant lacrimation. The high germ count of the air in the dwellings and the environment is an additional source of contamination to the conjunctiva.

Topics: Adolescent; Adult; Aged; Bacteria; Child; Child, Preschool; Conjunctiva; Conjunctivitis, Bacterial; Dose-Response Relationship, Drug; Egypt; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Ophthalmic Solutions; Povidone; Povidone-Iodine; Refuse Disposal

In Cairo's waste disposal sites conjunctivitis is frequently found resulting from the burning process of plastic, paper, etc.. Recurrent secondary contamination of the conjunctiva by pathogenic and non-pathogenic microorganisms often takes place; however, in certain germ species, the differentiation between pathogenic or non-pathogenic organisms within a damaged mucous membrane cannot be made. Furthermore, in this study, we have attempted to investigate germ reproduction during the application of PVP-eyedrops. However, our results cannot be conclusive because of the high environmental contamination, very low personal hygiene resulting from contaminated water and the constant exposure of samples to environmental contamination. Studies will be continued.

Topics: Air Microbiology; Bacteria; Bacteriological Techniques; Colony Count, Microbial; Conjunctiva; Conjunctivitis, Bacterial; Egypt; Humans; Ophthalmic Solutions; Povidone-Iodine; Refuse Disposal

Topics: Conjunctivitis, Bacterial; Female; Humans; Male; Ophthalmic Solutions; Povidone; Povidone-Iodine