DOI: https://doi.org/10.18370/2309-4117.2018.44.43-48

Povidon-iodine (betadine) in modern obstetric-gynecological practice

О. М. Носенко, Т. Я. Москаленко, А. В. Рутинская

Abstract


The article describes the pharmacocodynamics of povidone-iodine, the release form under the brand name Betadine, pharmacological benefits, as well as evidence of its effectiveness in preventing infection in the field of surgical intervention. Povidone-iodine is indicated to be a depot of iodine, constantly releasing elemental iodine, which has strong oxidizing properties, and therefore most microorganisms are destroyed in vitro in less than a minute, and the main destructive effect of the drug occurs in the first 15–30 seconds. Povidone-iodine has a wide spectrum of antimicrobial and antiviral action.

The data on medications of povidone-iodine in the form of vaginal suppositories, antiseptic solution and ointment under the trade name Betadine are presented. Own data on the effective use of vaginal suppositories in symptomatic vaginal dysbiosis caused by mixed opportunistic bacterial flora (facultative and obligate anaerobes) with the presence of Atopobium vaginae in diagnostically significant amounts are presented.

In the presented comparative studies, the advantages of Betadine compared with other antiseptics in the spectrum of microbiological effects, resistance of microorganisms, effects on wound healing, dependence of the effect on the physico-chemical parameters of the environment, side effects, the purpose of application – prevention and/or treatment are shown.

The results of recent comparative studies on the treatment of the surgical area with chlohexidine-alcohol and povidone-iodine, according to which povidone-iodine should still be considered acceptable for the preoperative treatment of the caesarean section, are highlighted. It is indicated that the irrigation of the wound cavity with an aqueous solution of povidone-iodine during surgery and before suturing the surgical wound is one of the WHO recommendations for the prevention of infection in the field of surgical intervention.

The authors conclude that povidone-iodine, including Betadine, has a broad spectrum of antimicrobial and antiviral activity; high activity in the presence of organic compounds (blood, pus); ability to penetrate through biofilms, necrotic tissue, eschar; low incidence of antiseptic resistance; positive dynamics of wound healing by preventing the spread of inflammation and increasing the ability to heal; well tolerated by patients; low cost; ease of use.


Keywords


povidone-iodine; Betadine; vaginal suppositories; ointment; solution; indications; spectrum of action; pharmacodynamics; resistance; dilution; protein medium; area of surgical intervention; wound healing; chlorhexidine; caesarean section

References


Rodin, A.V., Privolnev, V.V., Savkin, V.A. “Application of povidone-iodine for the treatment and prevention of wound infections in the surgeon practice.” Ambulatory Surgery 3–4.67–68 (2017): 43–51.

Taran, A. The use of antimicrobial drug betadin in the surgical clinic. Guidelines. Chisinau (2006).

Tikhomirov, A.L., Lubnin, D.M., Yudaev, V.N. “The drug «Betadine» in the treatment and prevention of inflammatory diseases of the female genital organs.” Difficult patient 12.9 (2011): 36–8.

Chekmareva, I.A., Blatun, L.A., Terekhova, R.P., et al. “Morphofunctional aspects of wound regeneration in the treatment of iodine-containing ointments.” Surgery 1 (2014): 54–8.

Kim, S.S., Yu, S.B., Kim, J.D., Ryu, S.J. “Comparison of disinfective power according to application order of 70% isopropyl alcohol and 10% povidone-iodine.” Korean J Anesthesiol 65.6 (2013): 519–24.

Bigliardi, P.L., Alsagoff, S.A.L., El-Kafrawi, H.Y., et al. “Povidone iodine in wound healing: A review of current concepts and practices.” Int J Surg 44 (2017): 260–8.

Brown, N.M., Cipriano, C.A., Moric, M., et al. “Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection.” J Arthroplasty 27.1 (2012): 27–30.

Cheng, M.T., Chang, M.C., Wang, S.T., et al. “Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Phila Pa 1976) 30.15 (2005): 1689–93.

Dumville, J.C., McFarlane, E., Edwards, P., et al. “Preoperative skin antiseptics for preventing surgical wound infections after clean surgery.” Cochrane Database Syst Rev 4 (2015): CD003949. DOI: 10.1002/14651858. CD003949.pub4

Food and Drug Administration. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. Available from: [https://www. fda.gov/Drugs/DrugSafety/ucm530975.htm], last accessed Nov 30, 2018.

Giordano, S., Peltoniemi, H., Lilius, P., Salmi, A. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthet Surg J 33.5 (2013): 675–80.

World Health Organization. Global guidelines for the prevention of surgical site infection. WHO. Geneva (2016): 184 p.

Hakkarainen, T.W., Dellinger, E.P., Evans, H.L., et al. “Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program.” J Am Coll Surg 218.3 (2014): 336–44.

Hoekstra, M.J., Westgate, S.J., Mueller, S. “Povidone-iodine ointment demonstrates in vitro efficacy against biofilm formation.” Int Wound J 14.1 (2017): 172–9. DOI: 10.1111/iwj.12578

Kawana, R., et al. “Inactivation of human viruses by povidone-iodine in comparison with other antiseptics.” Dermatology 195 Suppl 2 (1997): 29–35.

Maiwald, M. “Skin preparation for prevention of surgical site infection after Cesarean delivery: a randomized controlled trial.” Obstet Gynecol 129.4 (2017): 750–1.

Sindelar, W.F., Mason, G.R. “Intraperitoneal irrigation with povidone-iodine solution for the prevention of intra-abdominal abscesses in the bacterially contaminated abdomen.” Surg Gynecol Obstet 148.3 (1979): 409–11.

Springel, E.H., Wang, X.Y., Sarfoh, V.M., et al. “A randomized open-label controlled trial of chlorhexidine-alcohol vs povidone-iodine for cesarean antisepsis: the CAPICA trial.” Am J Obstet Gynecol 217.4 (2017): 463. e1–463.e8. DOI: 10.1016/j.ajog.2017.05.060


GOST Style Citations


1.           Родин, А.В. Применение повидон-йода для лечения и профилактики раневых инфекций в практике врача-хирурга / А.В. Родин, В.В. Привольнев, В.А. Савкин // Амбулаторная хирургия. – 2017. – № 3–4 (67–68). – С. 43–51.

2.           Таран, А. Использование антимикробного средства бетадин в хирургической клинике. Методические рекомендации. – Кишинев, 2006.

3.           Тихомиров, А.Л. Препарат «Бетадин» в лечении и профилактике воспалительных заболеваний женских половых органов / А.Л. Тихомиров, Д.М. Лубнин, В.Н. Юдаев // Трудный пациент. – 2011. – № 12, Том 9. – С. 36–38.

4.           Чекмарева, И.А. Морфофункциональные аспекты регенерации ран при лечении йодсодержащими мазями / И.А. Чекмарева, Л.А. Блатун, Р.П. Терехова и др. // Хирургия. – 2014. – № 1. – С. 54–58.

5.           Kim, S.S., Yu, S.B., Kim, J.D., Ryu, S.J. “Comparison of disinfective power according to application order of 70% isopropyl alcohol and 10% povidone-iodine.” Korean J Anesthesiol 65.6 (2013): 519–24.

6.           Bigliardi, P.L., Alsagoff, S.A.L., El-Kafrawi, H.Y., et al. “Povidone iodine in wound healing: A review of current concepts and practices.” Int J Surg 44 (2017): 260–8.

7.           Brown, N.M., Cipriano, C.A., Moric, M., et al. “Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection.” J Arthroplasty 27.1 (2012): 27–30.

8.           Cheng, M.T., Chang, M.C., Wang, S.T., et al. “Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Phila Pa 1976) 30.15 (2005): 1689–93.

9.           Dumville, J.C., McFarlane, E., Edwards, P., et al. “Preoperative skin antiseptics for preventing surgical wound infections after clean surgery.” Cochrane Database Syst Rev 4 (2015): CD003949. DOI: 10.1002/14651858. CD003949.pub4

10.         Food and Drug Administration. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. Available from: [https://www. fda.gov/Drugs/DrugSafety/ucm530975.htm], last accessed Nov 30, 2018.

11.         Giordano, S., Peltoniemi, H., Lilius, P., Salmi, A. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthet Surg J 33.5 (2013): 675–80.

12.         World Health Organization. Global guidelines for the prevention of surgical site infection. WHO. Geneva (2016): 184 p.

13.         Hakkarainen, T.W., Dellinger, E.P., Evans, H.L., et al. “Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the Washington State Surgical Care and Outcomes Assessment Program.” J Am Coll Surg 218.3 (2014): 336–44.

14.         Hoekstra, M.J., Westgate, S.J., Mueller, S. “Povidone-iodine ointment demonstrates in vitro efficacy against biofilm formation.” Int Wound J 14.1 (2017): 172–9. DOI: 10.1111/iwj.12578

15.         Kawana, R., et al. “Inactivation of human viruses by povidone-iodine in comparison with other antiseptics.” Dermatology 195 Suppl 2 (1997): 29–35.

16.         Maiwald, M. “Skin preparation for prevention of surgical site infection after Cesarean delivery: a randomized controlled trial.” Obstet Gynecol 129.4 (2017): 750–1.

17.         Sindelar, W.F., Mason, G.R. “Intraperitoneal irrigation with povidone-iodine solution for the prevention of intra-abdominal abscesses in the bacterially contaminated abdomen.” Surg Gynecol Obstet 148.3 (1979): 409–11.

18.         Springel, E.H., Wang, X.Y., Sarfoh, V.M., et al. “A randomized open-label controlled trial of chlorhexidine-alcohol vs povidone-iodine for cesarean antisepsis: the CAPICA trial.” Am J Obstet Gynecol 217.4 (2017): 463. e1–463.e8. DOI: 10.1016/j.ajog.2017.05.060





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)