Povidone-iodine

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Povidone-iodine
ExAntiseptic.jpg
Povidone-iodine applied to an abrasion using a cotton swab.
Clinical data
Trade names Betadine, Wokadine, Pyodine, others
Other namespolyvidone iodine, iodopovidone
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administration 		Topical
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  • US: OTC / Rx-only
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  • 2-Pyrrolidinone, 1-ethenyl-, homopolymer
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Formula (C6H9NO)n·xI
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Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. [1] [2] It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. [2] It may also be used for minor wounds. [2] It may be applied to the skin as a liquid, an ointment or a powder. [2] [3]

Contents

Side effects include skin irritation and sometimes swelling. [1] If used on large wounds, kidney problems, high blood sodium, and metabolic acidosis may occur. [1] It is not recommended in women who are less than 32 weeks pregnant. [2] Frequent use is not recommended in people with thyroid problems or who are taking lithium. [2]

Povidone-iodine is a chemical complex of povidone, hydrogen iodide, and elemental iodine. [4] The recommended strength solution contains 10% Povidone, with total iodine species equaling 10,000 ppm or 1% total titratable iodine. [4] It works by releasing iodine which results in the death of a range of microorganisms. [1]

Povidone-iodine came into commercial use in 1955. [5] It is on the World Health Organization's List of Essential Medicines. [6] Povidone-iodine is available over the counter. [7] It is sold under a number of brand names including Betadine. [2]

Medical uses

Wound area covered in povidone-iodine. Gauze has also been applied. Gauze in medical useage - wound.JPG
Wound area covered in povidone-iodine. Gauze has also been applied.

Povidone-iodine is a broad spectrum antiseptic for topical application in the treatment and prevention of wound infection. It may be used in first aid for minor cuts, burns, abrasions and blisters. Povidone-iodine exhibits longer lasting antiseptic effects than tincture of iodine, due to its slow absorption via soft tissue, making it the choice for longer surgeries. Chlorhexidine is almost twice as effective in preventing infection after surgery with a similar to lower risk of adverse events, [8] [9] and the combination of sodium hypochlorite and hypochlorous acid in very low concentration is significantly superior for wound healing. [10]

Consequently, PVP-I has found broad application in medicine as a surgical scrub; for pre- and post-operative skin cleansing; for the treatment and prevention of infections in wounds, ulcers, cuts and burns; for the treatment of infections in decubitus ulcers and stasis ulcers; in gynecology for vaginitis associated with candidal, trichomonal or mixed infections. For these purposes PVP-I has been formulated at concentrations of 7.5–10.0% in solution, spray, surgical scrub, ointment, and swab dosage forms; however, use of 10% povidone-iodine though recommended, is infrequently used, as it is poorly accepted by health care workers and is excessively slow to dry. [11] [12]

Because of these critical indications, only sterile povidone-iodine should be used in most cases. Non-sterile product can be appropriate in limited circumstances in which people have intact, healthy skin that will not be compromised or cut. The non-sterile form of Povidone iodine has a long history of intrinsic contamination with Burkholderia cepacia (a.k.a.Pseudomonas cepacia), and other opportunistic pathogens. Its ability to harbor such microbes further underscores the importance of using sterile products in any clinical setting. Since these bacteria are resistant to povidone iodine, statements that bacteria do not develop resistance to PVP-I, [13] should be regarded with great caution: some bacteria are intrinsically resistant to a range of biocides including povidone-iodine. [14]

Eyes

A buffered PVP-I solution of 2.5% concentration can be used for prevention of neonatal conjunctivitis, especially if it is caused by Neisseria gonorrhoeae , or Chlamydia trachomatis . It is currently unclear whether PVP-I is more effective in reducing the number of cases of conjunctivitis in neonates over other methods. [15] PVP-I appears to be very suitable for this purpose because, unlike other substances, it is also efficient against fungi and viruses (including HIV and Herpes simplex ). [16]

Pleurodesis

It is used in pleurodesis (fusion of the pleura because of incessant pleural effusions). For this purpose, povidone-iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost. [17]

Alternatives

There is strong evidence that chlorhexidine and denatured alcohol used to clean skin prior to surgery is better than any formulation of povidone-iodine. [8]

Contraindications

PVP-I is contraindicated in people with hyperthyroidism (overactive thyroid gland) and other diseases of the thyroid, after treatment with radioiodine, and in people with dermatitis herpetiformis [ why? ] (Duhring's disease). [18]

Side effects

The sensitization rate to the product is 0.7%. [19]

Interactions

The iodine in PVP-I reacts with hydrogen peroxide, silver, taurolidine and proteins such as enzymes, rendering them (and itself) ineffective. It also reacts with many mercury compounds, giving the corrosive compound mercury iodide, as well as with many metals, making it unsuitable for disinfecting metal piercings. [18]

Iodine is absorbed into the body to various degrees, depending on application area and condition of the skin. As such, it interacts with diagnostic tests of the thyroid gland such as radioiodine diagnostics, as well as with various diagnostic agents used on the urine and stool, for example Guaiacum resin. [18]

Structure

Structure of povidone-iodine complex. Povidone-iodine.svg
Structure of povidone-iodine complex.

Povidone-iodine is a chemical complex of the polymer povidone (polyvinylpyrrolidone, PVP) and triiodide (I−
3). [20] It is synthesized by mixing the PVP polymer with iodine (I2), allowing the two to react. [21]

It is soluble in cold and mild-warm water, ethyl alcohol, isopropyl alcohol, polyethylene glycol, and glycerol. Its stability in solution is much greater than that of tincture of iodine or Lugol's solution.

Free iodine, slowly liberated from the povidone-iodine (PVP-I) complex in solution, kills cells through iodination of lipids and oxidation of cytoplasmic and membrane compounds. This agent exhibits a broad range of microbiocidal activity against bacteria, fungi, protozoa, and viruses. Slow release of iodine from the PVP-I complex in solution minimizes iodine toxicity towards mammalian cells.

PVP-I can be loaded into hydrogels, which can be based on carboxymethyl cellulose (CMC), poly(vinyl alcohol) (PVA), and gelatin, or on crosslinked polyacrylamide. These hydrogels can be used for wound dressing. The rate of release of the iodine in the PVP-I is heavily dependent on the hydrogel composition: it increases with more CMC/PVA and decreases with more gelatin.

History

Following the discovery of iodine by Bernard Courtois in 1811, it has been broadly used for the prevention and treatment of skin infections, as well as the treatment of wounds. Iodine has been recognized as an effective broad-spectrum bactericide, and is also effective against yeasts, molds, fungi, viruses, and protozoans. Drawbacks to its use in the form of aqueous solutions include irritation at the site of application, toxicity, and the staining of surrounding tissues. These deficiencies were overcome by the discovery and use of PVP-I, in which the iodine is carried in a complexed form and the concentration of free iodine is very low. The product thus serves as an iodophor.

PVP-I was discovered in 1955, at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski. [22] They carried out tests in vitro to demonstrate anti-bacterial activity, and found that the complex was less toxic in mice than tincture of iodine. Human clinical trials showed the product to be superior to other iodine formulations. [23]

Research

Schematic of povidone-iodine complex wrapping a single wall carbon nanotube (black). PVP-I-CNT.jpg
Schematic of povidone-iodine complex wrapping a single wall carbon nanotube (black).

Povidone-iodine has found application in the field of nanomaterials. [25] A wound-healing application has been developed which employs a mat of single wall carbon nanotubes (SWNTs) coated in a monolayer of povidone-iodine. [24]

Research has previously found that the polymer polyvinylpyrrolidone (PVP, povidone) can coil around individual carbon nanotubes to make them water-soluble. [26]

Related Research Articles

<span class="mw-page-title-main">Mouthwash</span> Liquid rinse for oral hygiene

Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.

A bactericide or bacteriocide, sometimes abbreviated Bcidal, is a substance which kills bacteria. Bactericides are disinfectants, antiseptics, or antibiotics. However, material surfaces can also have bactericidal properties based solely on their physical surface structure, as for example biomaterials like insect wings.

<span class="mw-page-title-main">Polyvinylpyrrolidone</span> Water-soluble polymer

Polyvinylpyrrolidone (PVP), also commonly called polyvidone or povidone, is a water-soluble polymer compound made from the monomer N-vinylpyrrolidone. PVP is available in a range of molecular weights and related viscosities, and can be selected according to the desired application properties.

An antiseptic is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection or putrefaction. Antiseptics are generally distinguished from antibiotics by the latter's ability to safely destroy bacteria within the body, and from disinfectants, which destroy microorganisms found on non-living objects.

<span class="mw-page-title-main">Central venous catheter</span> A tubular device placed in a large vein used to administer medicines

A central venous catheter (CVC), also known as a central line (c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access. These catheters are commonly placed in veins in the neck, chest, groin, or through veins in the arms.

<span class="mw-page-title-main">Tincture of iodine</span> Antiseptic solution rubbed on skin before surgical operations

Tincture of iodine, iodine tincture, or weak iodine solution is an antiseptic. It is usually 2 to 3% elemental iodine, along with potassium iodide or sodium iodide, dissolved in a mixture of ethanol and water. Tincture solutions are characterized by the presence of alcohol. It was used from 1908 in pre-operative skin preparation by Italian surgeon Antonio Grossich.

<span class="mw-page-title-main">Chlorhexidine</span> Disinfectant and antiseptic

Chlorhexidine is a disinfectant and antiseptic with the molecular formula C22H30Cl2N10, which is used for skin disinfection before surgery and to disinfect surgical instruments. It is also used for cleaning wounds, preventing dental plaque, treating yeast infections of the mouth, and to keep urinary catheters from blocking. It is used as a liquid or a powder. It is commonly used in salt form, either the gluconate or the acetate.

<span class="mw-page-title-main">Pleurodesis</span> Medical procedure on pleural cavity

Pleurodesis is a medical procedure in which part of the pleural space is artificially obliterated. It involves the adhesion of the visceral and the costal pleura. The mediastinal pleura is spared.

Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.

<span class="mw-page-title-main">Merbromin</span> Organomercuric antiseptic for external use on minor cuts

Merbromin is an organomercuric disodium salt compound used as a topical antiseptic for minor cuts and scrapes and as a biological dye. Readily available in most countries, it is no longer sold in Switzerland, Brazil, France, Iran, Germany, Denmark, or the United States, due to its mercury content.

<span class="mw-page-title-main">Iodophor</span> Soluble complex that can release iodine

An iodophor is a preparation containing iodine complexed with a solubilizing agent, such as a surfactant or water-soluble polymers such as povidone, The result is a water-soluble material that releases free iodine when in solution.

<span class="mw-page-title-main">Asepsis</span> Absence of disease-causing microorganisms

Asepsis is the state of being free from disease-causing micro-organisms. There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived from the older antiseptic techniques, a shift initiated by different individuals in the 19th century who introduced practices such as the sterilizing of surgical tools and the wearing of surgical gloves during operations. The goal of asepsis is to eliminate infection, not to achieve sterility. Ideally, a surgical field is sterile, meaning it is free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation. Even in an aseptic state, a condition of sterile inflammation may develop. The term often refers to those practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection.

<span class="mw-page-title-main">Dressing (medicine)</span> Sterile pad or compress applied to wounds

A dressing or compress is piece of material such as a pad applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place. Modern dressings are sterile.

<i>Burkholderia cepacia</i> complex Species of bacterium

Burkholderia cepacia complex (BCC) is a species complex consisting of Burkholderia cepacia and at least 20 different biochemically similar species of Gram-negative bacteria. They are catalase-producing and lactose-nonfermenting. Members of BCC are opportunistic human pathogens that most often cause pneumonia in immunocompromised individuals with underlying lung disease. Patients with sickle-cell haemoglobinopathies are also at risk. The species complex also attacks young onion and tobacco plants, and displays a remarkable ability to digest oil.

<span class="mw-page-title-main">Cadexomer iodine</span> Chemical compound

Cadexomer iodine is an iodophor that is produced by the reaction of dextrin with epichlorhydrin coupled with ion-exchange groups and iodine. It is a water-soluble modified starch polymer containing 0.9% iodine, calculated on a weight-weight basis, within a helical matrix.

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<span class="mw-page-title-main">Inadine</span> Surgical dressing

Inadine is an iodine-containing non-sticky surgical dressing consisting of a knitted viscose fabric with a polyethylene glycol base that contains and slowly releases the antiseptic povidone-iodine (PVP-1). It is applied to superficial wounds.

Skin disinfection is a process that involves the application of a disinfectant to reduce levels of microorganisms on the skin. Disinfecting the skin of the patient and the hands of the healthcare providers are an important part of surgery.

Iodine is a chemical element with many uses in medicine, depending on the form. Elemental iodine and iodophors are topical antiseptics. Iodine, in non-elemental form, functions as an essential nutrient in human biology. Organic compounds containing iodine are also useful iodinated contrast agents in X-ray imaging.

Decolonization, also bacterial decolonization, is a medical intervention that attempts to rid a patient of an antimicrobial resistant pathogen, such as methicillin-resistant Staphylococcus aureus (MRSA) or antifungal-resistant Candida.

References

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  2. 1 2 3 4 5 6 7 British National Formulary (BNF), 69th Edition. British Medical Association; Joint Formulary Committee. 6 March 2015. p. 840. ISBN   978-0-85711-156-2. OCLC   1031488649. Archived from the original on 22 February 2022.
  3. ↑ "Povidone iodine topical". drugs.com. Retrieved 11 May 2024.
  4. 1 2 Encyclopedia of polymer science and technology (3rd ed.). Wiley Publishing. 16 October 2013. p. 728. ISBN   978-0-470-07369-8. OCLC   899175361. Archived from the original on 13 January 2017.
  5. ↑ Sneader W (31 October 2005). Drug Discovery: A History. John Wiley & Sons. p. 68. ISBN   978-0-470-01552-0. OCLC   62301847. Archived from the original on 13 January 2017.
  6. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  7. ↑ "Povidone/iodine solution: Indications, Side Effects, Warnings - Drugs.com". www.drugs.com. Archived from the original on 13 January 2017. Retrieved 11 January 2017.
  8. 1 2 Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O (September 2020). "The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis". Annals of Surgery. 274 (6): e481–e488. doi: 10.1097/SLA.0000000000004076 . PMID   32773627.
  9. ↑ Chen S, Chen JW, Guo B, Xu CS (May 2020). "Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta-analysis". World Journal of Surgery. 44 (5): 1412–1424. doi:10.1007/s00268-020-05384-7. ISSN   1432-2323. PMID   31996985. S2CID   210950872.
  10. ↑ Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, et al. (2018). "Consensus on Wound Antisepsis: Update 2018". Skin Pharmacology and Physiology. 31 (1): 28–58. doi:10.1159/000481545. ISSN   1660-5527. PMID   29262416. S2CID   3601026.
  11. ↑ Slater K, Cooke M, Fullerton F, Whitby M, Hay J, Lingard S, et al. (September 2020). "Peripheral intravenous catheter needleless connector decontamination study-Randomized controlled trial". American Journal of Infection Control. 48 (9): 1013–1018. doi:10.1016/j.ajic.2019.11.030. PMID   31928890. S2CID   210193248.
  12. ↑ Slater K, Fullerton F, Cooke M, Snell S, Rickard CM (September 2018). "Needleless connector drying time-how long does it take?". American Journal of Infection Control. 46 (9): 1080–1081. doi:10.1016/j.ajic.2018.05.007. PMID   29880433. S2CID   46968733.
  13. ↑ Fleischer W, Reimer K (1997). "Povidone-iodine in antisepsis--state of the art". Dermatology. 195 (Suppl 2): 3–9. doi:10.1159/000246022. PMID   9403248.
  14. ↑ Rose H, Baldwin A, Dowson CG, Mahenthiralingam E (March 2009). "Biocide susceptibility of the Burkholderia cepacia complex". The Journal of Antimicrobial Chemotherapy. 63 (3): 502–10. doi: 10.1093/jac/dkn540 . PMC   2640157 . PMID   19153076.
  15. ↑ Martin I, Sawatzky P, Liu G, Mulvey MR (February 2015). "Neisseria gonorrhoeae in Canada: 2009-2013". Canada Communicable Disease Report. 41 (2): 35–41. doi: 10.1002/14651858.CD001862.pub3 . PMC   6457593 .
  16. ↑ Najafi Bi R, Samani SM, Pishva N, Moheimani F (2003). "Formulation and Clinical Evaluation of Povidone-Iodine Ophthalmic Drop". Iranian Journal of Pharmaceuticical Research. 2 (3): 157–160.
  17. ↑ Agarwal R, Khan A, Aggarwal AN, Gupta D (March 2012). "Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis". The Indian Journal of Medical Research. 135 (3): 297–304. PMC   3361864 . PMID   22561614.
  18. 1 2 3 Jasek W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag (Austrian pharmacist publishing company). pp. 983–5. ISBN   978-3-85200-181-4. Archived from the original on 22 February 2022.
  19. ↑ Niedner R (1997). "Cytotoxicity and sensitization of povidone-iodine and other frequently used anti-infective agents". Dermatology. 195 (Suppl 2): 89–92. doi:10.1159/000246038. PMID   9403263.
  20. ↑ Kutscher B (June 2000). "Dermatologicals (D), 4. Antiseptics and Disinfectants (D 08), Anti-Acne Preparations (D 10), and Other Dermatological Preparations (D 11).". Ullmann's Encyclopedia of Industrial Chemistry. pp. 1–22. doi:10.1002/14356007.w08_w03. ISBN   978-3-527-30385-4. S2CID   225472250. Archived from the original on 22 February 2022. Retrieved 22 February 2022.
  21. ↑ Makhayeva DN, Irmukhametova GS, Khutoryanskiy VV (January 2020). "Polymeric Iodophors: Preparation, Properties, and Biomedical Applications". Review Journal of Chemistry. 10 (1): 40–57. doi: 10.1134/S2079978020010033 . PMC   7749746 . PMID   33362938. Three methods are used to obtain povidone–iodine: exposing the polymer to iodine vapors [36], mixing PVP and iodine solutions [37], and heating dry PVP and iodine samples at 80–90°C until the titrated iodine concentration is constant [35].
  22. ↑ U.S. patent 2,739,922
  23. ↑ Walter S (23 June 2005). Drug Discovery: A History. New York: John Wiley & Sons. p. 68. ISBN   978-0-471-89979-2. OCLC   318418088.
  24. 1 2 Simmons TJ, Lee SH, Park TJ, Hashim DP, Ajayan PM, Linhardt RJ (2009). "Antiseptic Single Wall Carbon Nanotube Bandages" (PDF). Carbon. 47 (6): 1561–1564. Bibcode:2009Carbo..47.1561S. doi:10.1016/j.carbon.2009.02.005. Archived from the original (PDF) on 21 June 2010.
  25. ↑ Makhayeva DN, Irmukhametova GS, Khutoryanskiy VV (8 November 2023). "Advances in antimicrobial polymeric iodophors". European Polymer Journal. 201: 112573. Bibcode:2023EurPJ.20112573M. doi: 10.1016/j.eurpolymj.2023.112573 . ISSN   0014-3057.
  26. ↑ Simmons TJ, Hashim D, Vajtai R, Ajayan PM (August 2007). "Large area-aligned arrays from direct deposition of single-wall carbon nanotube inks". Journal of the American Chemical Society. 129 (33): 10088–9. doi:10.1021/ja073745e. PMID   17663555.

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