Povidone-iodine

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Povidone-iodine
Povidone-iodine.svg
Clinical data
AHFS/Drugs.com International Drug Names
Routes of
administration
Topical
ATC code D08AG02 (WHO) D09AA09 (WHO) (dressing) D11AC06 (WHO) G01AX11 (WHO) R02AA15 (WHO) S01AX18 (WHO) QG51AD01 (WHO)
Legal status
Legal status
Identifiers
CAS Number 25655-41-8 YesY
PubChem (CID) 410087
ChemSpider none
UNII 85H0HZU99M YesY
ChEMBL CHEMBL1201724 YesY
Chemical and physical data
Formula (C6H9NO)n·xI
Molar mass variable
 NYesY (what is this?)  (verify)

Povidone-iodine (PVP-I), brand name Wokadine, Pyodine, and Betadine is a stable chemical complex of polyvinylpyrrolidone (povidone, PVP) and elemental iodine. It contains from 9.0% to 12.0% available iodine, calculated on a dry basis.[1]

This unique complex was discovered in 1955 at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski.[2] 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.[3]

Betadine was immediately marketed, and has since become the universally preferred iodine antiseptic.

It is on the WHO Model List of Essential Medicines, the most important products needed in a basic health system.[4]

Medical uses[edit]

Wound area covered in povidone-iodine. Gauze has also been applied.
Povidone-iodine applied to an abrasion using a cotton swab.

Povidone-iodine is a broad spectrum antiseptic for topical application in the treatment and prevention of infection in wounds, using the antiseptic properties of iodine. It may be used in first aid for minor cuts, grazes, 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 provides similar results, but with no toxicity concerns.

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.

In addition, it has been demonstrated that bacteria do not develop resistance to PVP-I,[5] and the sensitization rate to the product is only 0.7%[6] 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. It is available without a prescription under the generic name povidone-iodine or the brand name Betadine.

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.[7]

2.5% buffered PVP-I solution can be used for prophylaxis of neonatal conjunctivitis (Ophthalmia neonatorum) which can lead to blindness, especially if it is caused by Neisseria gonorrhoeae, or Chlamydia trachomatis. It is currently unclear whether PVP-I is more effective in reducing the incidence of conjunctivitis in neonates over other methods of prophylaxis.[8] 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).[9]

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.

Alternative[edit]

In a clinical study of approximately 850 patients which compared the efficacy of pre-operative skin cleansing using chlorhexidine-alcohol vs. povidone-iodine (PVP-I) in preventing post-operative infection, the rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the PVP-I group (overall, 9.5% vs. 16.1%).[10] Chlorhexidine-alcohol was significantly more protective than PVP-I against both superficial incisional infections (4.2% vs. 8.6%) and deep incisional infections (1% vs. 3%).

The incidence of organ-space infections was, however, not significantly different between the groups (4.4% vs. 4.5%). The team performing the study believes that, although both of the antiseptic preparations possess broad-spectrum antimicrobial activity, the more effective protection provided by chlorhexidine-alcohol may be due to its more rapid action, its persistent activity (even when exposed to bodily fluids), and some residual effect.[11] An alternative explanation is the dilution of the active antimicrobial agent (chlorhexidine) in isopropyl alcohol rather than water (iodine).

In a separate study a lower infection rate was seen with iodine povacrylex in isopropyl alcohol (DuraPrep) than with chlorhexidine in isopropyl alcohol (ChloraPrep) (3.9% compared with 7.1%; P = .002).[12]

Contraindications[edit]

PVP-I is contraindicated in patients with hyperthyroidism (overactive thyroid gland) and other diseases of the thyroid, after treatment with radioiodine, and in patients with dermatitis herpetiformis[why?] (Duhring's disease).[13]

Interactions[edit]

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.[13]

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.[13]

Properties[edit]

PVP-I is completely 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 eukaryotic or prokaryotic cells through iodination of lipids and oxidation of cytoplasmic and membrane compounds. This agent exhibits a broad range of microbicidal activity against bacteria, fungi, protozoa, and viruses. Slow release of iodine from the PVP-I complex in solution minimizes iodine toxicity towards mammalian cells.

Research[edit]

Alt text
Schematic of povidone-iodine complex wrapping a single wall carbon nanotube (black).[14]

Povidone-iodine has found application in the field of nanomaterials. A wound-healing application has been developed which employs a mat of single wall carbon nanotubes (SWNTs) coated in a monolayer of povidone-iodine.[14]

Research has previously found that the polymer polyvinylpyrrolidone (PVP, povidone) can coil around individual carbon nanotubes to make them water-soluble.[15]

See also[edit]

References[edit]

  1. ^ United States Pharmacopeia Archived July 11, 2007, at the Wayback Machine.
  2. ^ U.S.patent 2,739,922
  3. ^ Sneader, Walter (2005). Drug Discovery: A History. New York: John Wiley & Sons. p. 68. ISBN 0-471-89979-8. 
  4. ^ "19th WHO Model List of Essential Medicines (April 2015)" (PDF). WHO. April 2015. Retrieved May 10, 2015. 
  5. ^ Fleischer, W.; Reimer, K. (1997). "Povidone-iodine in antisepsis — State of the art". Dermatology. 195 (Suppl 2): 3–9. doi:10.1159/000246022. 
  6. ^ 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. 
  7. ^ Das SK, Saha SK, Das A, Halder AK, Banerjee SN, Chakraborty M (September 2008). "A study of comparison of efficacy and safety of talc and povidone iodine for pleurodesis of malignant pleural effusions". J Indian Med Assoc. 106 (9): 589–90, 592. PMID 19552086. 
  8. ^ Kapoor VS, Whyte R, Vedula SS (2016). "Interventions for preventing ophthalmia neonatorum". Cochrane Database Syst Rev. 9: CD001862. doi:10.1002/14651858.CD001862.pub3. 
  9. ^ Najafi Bi, R.; Samani, S. M.; Pishva, N.; Moheimani, F. (2003). "Formulation and Clinical Evaluation of Povidone-Iodine Ophthalmic Drop". Iranian Journal of Pharmaceuticical Research. 2 (3): 157–160. 
  10. ^ Rabih, O.; Darouiche, M. D.; et al. (2010). "Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis". New England Journal of Medicine. 362 (1): 18–26. doi:10.1056/NEJMoa0810988. PMID 20054046. 
  11. ^ Denton GW: Chlorhexidine, Disinfection, sterilization, and preservation 321 (5th ed.) 36 (2001)
  12. ^ Swenson, B. R.; Hendrick, T. L.; Metzger, R.; Bonatti, H.; Pruett, T. L.; Sawyer, R. G. (2009). "Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols". Infect Control Hosp Epidemiol. 30 (10): 964–971. doi:10.1086/605926. PMC 3371364Freely accessible. PMID 19732018. 
  13. ^ a b c Jasek, W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 983–5. ISBN 978-3-85200-181-4. 
  14. ^ a b Simmons, Trevor; Lee, S.-H.; Park, T.-J.; Hashim, D.P.; Ajayan, P.M.; Linhardt, R.J. (2009). "Antiseptic Single Wall Carbon Nanotube Bandages" (PDF). Carbon. 47 (6): 1561–1564. doi:10.1016/j.carbon.2009.02.005. 
  15. ^ Simmons, Trevor; Hashim, D; Vajtai, R; Ajayan, PM (2007). "Large Area-Aligned Arrays from Direct Deposition of Single-Wall Carbon Nanotubes". J. Am. Chem. Soc. 129 (33): 10088–10089. doi:10.1021/ja073745e. PMID 17663555. 

Further reading[edit]

  • Randolph H.L. Wong; Emily C.W. Hung; Vivien W.Y. Wong; Innes Y.P. Wan; Calvin S.H. Ng; Song Wan; Malcolm J. Underwood (2009). "Povidone-iodine wound irrigation: A word of caution". Surgical Practice. 13 (4): 123–4. doi:10.1111/j.1744-1633.2009.00461.x. 
  • Randolph H.L. Wong; Vivien W.Y. Wong; Emily C.W. Hung; Ping Yin Lee; Calvin S.H. Ng; Innes Y.P. Wan; Song Wan; Malcolm J. Underwood (2011). "Topical application of povidone-iodine before wound closure is associated with significant increase in serum iodine level". Surgical Practice. 19: 79–82. 
  • Randolph H.L. Wong; Calvin S.H. Ng; Malcolm J. Underwood (2011). "Iodine pleurodesis--a word of caution". European Journal of Cardio-Thoracic Surgery. 41 (5): 1209. doi:10.1093/ejcts/ezr137.