Polyhexamethylene Biguanide (PHMB): An Addendum to Current Topical Antimicrobials
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Thomas and McCubbin20,21 compared the in-vitro effectiveness of various silver containing products using 3 methods—zone of inhibition, challenge testing, and microbial transmission testing to demonstrate differences in the various dressings. Results against Staphylococcus aureus, Escherichia coli, and Candida albicans suggested that polyethylene mesh had the most rapid antimicrobial effect due to its rapid release of silver. Hydrocolloid was similar but had a slower onset. Activated carbon had little activity on the surface, but organisms that were absorbed into the dressing were inactivated by the silver.20
Jones et al22 found that some of the differences observed between polyethylene mesh and sodium CMC may be related to the conformability of the dressing. A greater wound bed conformability and contact correlated with an increased antimicrobial effect.
As described in the literature,6,20,21 there are a wide variety of silver dressings available and various in-vitro responses from these dressings. Well-designed and adequately powered randomized trials to support the clinical benefits of silver are lacking, are warranted, and requested by the medical community.
Iodine. Iodine is used as a disinfectant for cleaning surfaces and storage containers, in skin soaps, medicines, and for purifying water. It has been purported to have negative effects on wound healing, however some hypothesize that it may be due to the carrier.23 Carriers for iodine have demonstrated less toxicity by releasing iodine at a slower rate, yet show the same lethality as iodine in other forms. Cadexomer iodine (Iodoflex® and Iodosorb®, marketed in the United States by Smith & Nephew, Largo, Fla) is a 3-dimensional starch lattice formed into spherical microspheres that trap iodine in the lattice. As fluid is absorbed, the pore size of the lattice increases, releasing iodine. Mertz et al23 tested cadexomer iodine against MRSA in an in-vitro porcine model. They demonstrated significant reduction of the bacteria over a period of 72 hours.
Hansson and colleagues24 compared cadexomer iodine to hydrocolloid and paraffin gauze dressings in a randomized, open, controlled, multicenter clinical trial. In the 153-patient study they demonstrated 62% reduction in ulcer size with the cadexomer iodine as compared to 41% and 24% for the hydrocolloid and paraffin gauze, respectively. Patients were treated until the wound was dry or until 12 weeks, whichever came first. The investigators also compared the cost of the dressing over the 12-week period and demonstrated cost savings with the cadexomer iodine.24
Studies suggest that iodine’s mechanism of action is through destabilization of the bacterial cell wall and disruption of the membrane that results in leakage of the intracellular components.25
Polyhexamethylene biguanide (PHMB). Polyhexamethylene biguanide (PHMB), also known as polyhexanide and polyaminopropyl biguanide, is a commonly used antiseptic. It is used in a variety of products including wound care dressings, contact lens cleaning solutions, perioperative cleansing products, and swimming pool cleaners.
Wound care products containing PHMB include Kerlix AMD™, Excilon AMD™, and Telfa AMD™ (all from Tyco HealthCare Group, Mansfield, Mass) and XCell® Cellulose Wound Dressing Antimicrobial (Xylos Corp, Langhorne, Pa).
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