The effect of a wound care solution containing polyhexanide and betaine on bacterial counts: results of an in vitro study .
Minnich Kevin E,Stolarick Rebecca,Wilkins Robert G,Chilson Gary,Pritt Stacy L,Unverdorben Martin
Polyhexanide and betaine topical solution is used in the management of infected wounds as a cleaning agent. An in vitro study was conducted to examine the antimicrobial effects of a solution containing 0.1% of the antimicrobial agent polyhexanide and 0.1% of the surfactant betaine. Three batches of each product were tested, and culture results of 13 microorganisms were evaluated after 7, 14, and 28 days using USP <51> methodology. Growth reduction was identical at each day following exposure to the solution in all micro-organisms except Aspergillus brasiliensis. A range of 5.3-log to 5.8-log reduction was seen for the following micro-organisms: Staphylococcus epidermidis, Pseudomonas aeruginosa, Serratia marcescens, Candida albicans, S. aureus, vancomycin-resistant Enterococcus faecalis, Proteus mirabilis, Escherichia coli, methicillin-resistant S. aureus, Acinetobacter baumannii, Enterobacter cloacae, and E. faecalis. For A. brasiliensis, reductions were 2.1-log, 2.3-log and 2.8-log at 7, 14, and 28 days, respectively. The results of this study indicate a 4+ log inhibition of activity in 12 of 13 micro-organisms exposed to the solution. Research to elucidate the potential clinical effects of these observations is needed.
Toxicological assessment of polyhexamethylene biguanide for water treatment.
Asiedu-Gyekye Isaac J,Mahmood Abdulai Seidu,Awortwe Charles,Nyarko Alexander K
Polyhexamethylene biguanide (PHMB) is an antiseptic with antiviral and antibacterial properties used in a variety of products including wound care dressings, contact lens cleaning solutions, perioperative cleansing products, and swimming pool cleaners. There are regulatory concerns with regard to its safety in humans for water treatment. We decided to assess the safety of this chemical in Sprague-Dawley rats. PHMB was administered in a single dose by gavage via a stomach tube as per the manufacturer's instruction within a dose range of 2 mg/kg to 40 mg/kg. Subchronic toxicity studies were also conducted at doses of 2 mg/kg, 8 mg/kg and 32 mg/kg body weight and hematological, biochemical and histopathological findings of the major organs were assessed. Administration of a dose of 25.6 mg/kg, i.e. 1.6 mL of 0.4% PHMB solution (equivalent to 6.4x10(3) mg/L of 0.1% solution) resulted in 50% mortality. Histopathological analysis in the acute toxicity studies showed that no histopathological lesions were observed in the heart and kidney samples but 30% of the animals had mild hydropic changes in zone 1 of their liver samples, while at a dosage of 32 mg/kg in the subchronic toxicity studies, 50% of the animals showed either mild hepatocyte cytolysis with or without lymphocyte infiltration and feathery degeneration. Lymphocyte infiltration was, for the first time, observed in one heart sample, whereas one kidney sample showed mild tubular damage. The acute studies showed that the median lethal dose (LD50) is 25.6 mg/kg (LC50 of 1.6 mL of 0.4% PHMB. Subchronic toxicological studies also revealed few deleterious effects on the internal organs examined, as seen from the results of the biochemical parameters evaluated. These results have implications for the use of PHMB to make water potable.
Interaction and effectiveness of antimicrobials along with healing-promoting agents in a novel biocellulose wound dressing.
Napavichayanun Supamas,Amornsudthiwat Phakdee,Pienpinijtham Prompong,Aramwit Pornanong
Materials science & engineering. C, Materials for biological applications
An ideal wound dressing should keep the wound moist, allow oxygen permeation, adsorb wound exudate, accelerate re-epithelialization for wound closure, reduce pain and healing time, and prevent infection. Our novel biocellulose-based wound dressing was composed of three components: 1) biocellulose (BC), intended to create a moist and oxygen-permeated environment with exudate adsorption; 2) silk sericin (SS) known for its enhancement of collagen type I production, which is critical for re-epithelialization; and 3) the antiseptic polyhexamethylene biguanide (PHMB). To deliver an effective BC wound dressing, the interactions between the components (PHMB vs. SS) needed to be thoroughly analyzed. In this study, we investigated important parameters such as the loading sequence, loading concentration, and loading amount of the active compounds to ensure that the BC wound dressing could provide both antimicrobial activity and promote collagen production during healing. The loading sequence of SS and PHMB into BC was critical to maintain PHMB antimicrobial activity; silk sericin needed to be loaded before PHMB to avoid any negative impacts. The minimum PHMB concentration was 0.3% w/v for effective elimination of all tested bacteria (Bacillus subtilis, Staphylococcus aureus, methicillin-resistant S. aureus, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa). The amounts of SS and PHMB in BC were optimized to ensure that the dressings released the optimal amounts of both SS to enhance fibroblast collagen production and PHMB for effective antimicrobial activity.
Clinical use of polihexanide on acute and chronic wounds for antisepsis and decontamination.
Eberlein T,Assadian O
Skin pharmacology and physiology
Polihexanide is an antimicrobial compound suitable for clinical use in critically colonized or infected acute and chronic wounds. Its beneficial characteristic is attributable particularly to its broad antimicrobial spectrum, good cell and tissue tolerability, ability to bind to the organic matrix, low risk of contact sensitization, and wound healing promoting effect. In addition, no development of microorganism resistance during polihexanide use has been detected to date, nor does this risk appear imminent. The aim of therapy using polihexanide is to reduce the pathogen burden in a critically colonized or infected acute or chronic wound. An increasing number of articles on the subject of wound antisepsis with polihexanide can be found in the medical literature. However, there is still little published information on the practical use of polihexanide-containing wound antiseptics. The purpose of this review article is to describe the handling and the different possibilities of use of polihexanide-containing preparations, including the currently approved indications, contraindications and reservations. The use of polihexanide is not the only therapeutic option in management of wounds; therefore, priority is also given to prior surgical debridement and clarification of the cause of the underlying disease, including appropriate therapy.
Polihexanide for wound treatment--how it began.
Roth B,Brill F H H
Skin pharmacology and physiology
The essential role of wound antiseptics was discovered in the 18th century. Since then, many different procedures and substances have been developed and used for this indication. In the 1980s, polihexanide was introduced by Prof. Willenegger in Switzerland. Today, consensus recommendations confirm the potential of this substance for wound treatment. Various polihexanide-containing wound care products are available and these are now also gaining in importance throughout Europe and throughout the world.
The Effectiveness of Topical Polyhexamethylene Biguanide (PHMB) Agents for the Treatment of Chronic Wounds: A Systematic Review.
To Eliot,Dyck Rebecca,Gerber Stephanie,Kadavil Shauna,Woo Kevin Y
Surgical technology international
INTRODUCTION:This is the first systematic review to explore the evidence on PHMB and determine how effective this topical agent is for the treatment of chronic wounds. MATERIALS AND METHODS:PubMed, Ovid MEDLINE, CINAHL, Embase, the Cochrane library, and Scopus were searched for relevant articles published from 1946 to February 3, 2014, with no restrictions on publication status. ProQuest was searched for relevant dissertations, editorials, and conference abstracts. Non-indexed journals were searched and companies that manufacture wound care materials containing PHMB were contacted for unpublished data. Only randomized controlled trials available in English were included. Bias was assessed using the CONSORT document for all included studies. After inclusion and exclusion criteria were determined, four reviewers (ET, SK, SG, RD) independently reviewed each title and abstract of the literature search results to determine whether the paper should be included for this review. When disagreements on study inclusion emerged, reviewers resolved them through discussion. RESULTS:Of the 1,725 articles identified in the search, 6 met inclusion criteria. Four studies reported wound healing. Two of these studies evaluated changes in wound surface area and the other two evaluated wound bed evolution with variable results. In five studies, participants randomly assigned to PHMB topical agents showed significant improvement in bacterial control compared to control groups. Five studies reported pain reduction from the use of PHMB agents. DISCUSSION:There were a small number of eligible studies found, but the interventions, outcome measures, and outcome reporting varied greatly, making meta-analysis impossible. PHMB agents were shown to promote healing and reduce pain more effectively than control treatments. CONCLUSION:The existing evidence shows that topical PHMB may promote healing of chronic stalled wounds, reduce bacterial burden, eliminate methicillin-resistant staphylococcus aureus (MRSA), and alleviate wound-related pain.
Influence of the incorporation of the antimicrobial agent polyhexamethylene biguanide on the properties of dense and porous chitosan-alginate membranes.
Bueno Cecilia Zorzi,Moraes Ângela Maria
Materials science & engineering. C, Materials for biological applications
This work is a continuation of a previous study which described the development of dense and porous chitosan-alginate polyelectrolyte complexes through the addition of different amounts of Pluronic F68 to the polymeric mixture. The present study consisted in the incorporation of an antimicrobial agent, polyhexamethylene biguanide (PHMB), to the previously developed system. PHMB was incorporated at 1 and 10% (w/w) with high incorporation efficiencies, varying from 72 to 86%. Release profiles in phosphate buffered saline were evaluated using the Korsmeyer-Peppas equation, which suggested a quasi-Fickian diffusion mechanism for all obtained formulations. The maximum release percentage was approximately 15% as a result from the high affinity between PHMB and the polysaccharides. The obtained polyelectrolyte complexes were able to prevent the growth of both Staphylococcus aureus and Pseudomonas aeruginosa on their surfaces, being considered potentially effective wound dressings.
A Comparison of the Effects of Topical Prolavacid Solution (a Polyhexamethylene Biguanide-Based Wound Cleanser) and Medihoney Ointment in a Rat Model of Cutaneous Wound.
Paydar Shahram,Ziaeian Bijan,Dehghanian Amirreza,Heidarpour Mohsen,Alavi Moghadam Roshanak,Dalfardi Behnam,Hallaj Karladani Abbas
Advances in wound care
This experimental work examined the healing effect and probable adverse impact of topical Prolavacid solution (a polyhexamethylene biguanide-based wound cleanser) and topical Medihoney ointment in an animal model of cutaneous wound. We randomly divided 22 adult Sprague-Dawley rats (all were male) in two groups ( = 11): (1) those for which Prolavacid solution was poured on the skin wound surface; and (2) those animals for which Medihoney ointment was applied to the wounds. These two agents were applied daily throughout the study period (21 days). We photographically followed the wounds' contraction with imaging performed on days 0, 7, and 21 postwounding. The histopathologic features of the healing wounds were evaluated using skin biopsies taken on days 7 and 21 postwounding. The difference in mean wound surface area between two groups was not statistically significant on the examined days. Histopathological assessment indicated no statistically significant difference between the Prolavacid- and Medihoney-treated groups on days 7 and 21. We did not detect tissue necrosis following the topical application of Prolavacid solution. This was the first study to examine the efficacy and probable adverse consequences of topical Prolavacid on cutaneous wound healing process. Our work showed no statistically significant difference between the efficacy of daily topical application of Prolavacid and Medihoney products on the healing process of fresh cutaneous wounds in our rat model.
Polyhexamethylene biguanide dressings in wound management.
Nursing standard (Royal College of Nursing (Great Britain) : 1987)
This article describes wound management using polyhexamethylene biguanide dressings in two patients experiencing multiple comorbidities. Wound bed debridement and bioburden management were important factors in achieving positive results in terms of promoting wound healing and reducing infection and malodour.