Povidone-Iodine 10% alcoholic solution

Background. In the context of increasing antimicrobial resistance, prevention and management of infectious complications in invasive gynecology require a shift away from strategies based predominantly on systemic antibiotic prophylaxis. Results. This review summarizes the current evidence on the use of povidone-iodine as a broad-spectrum topical antiseptic in obstetric and gynecological practice, with particular emphasis on invasive and minimally invasive procedures. Povidone-iodine is a complex of iodine with polyvinylpyrrolidone that provides controlled release of active iodine and rapid antimicrobial activity. It is effective against Gram-positive and Gram-negative bacteria, fungi, viruses (including human papillomavirus), protozoa. Importantly, no microbial resistance to povidone-iodine has been documented despite decades of clinical use. Its mechanism of action involves multi-target oxidative damage to microbial cell membranes, proteins, and nucleic acids, which prevents the development of resistant strains. The article discusses the chemical and biological properties of povidone-iodine, including its pH level close to the physiological one, and its relevance following vaginal procedures involving stabilized hyaluronic acid or poly-L-lactic acid. Special attention is given to safety and tolerability. Evidence indicates that local use in non-pregnant women results in minimal systemic iodine absorption without clinically significant thyroid dysfunction, whereas use during pregnancy should be restricted to strict indications due to potential fetal thyroid effects. Randomized controlled trials and meta-analyses demonstrate that vaginal cleansing with povidone-iodine before cesarean section, hysterectomy, intrauterine device insertion, and other gynecological interventions significantly reduces the incidence of postoperative infections, including endometritis. The use of povidone-iodine allows effective infection prevention without routine systemic antibiotics, which is particularly important in the era of antibiotic resistance. The review concludes that povidone-iodine, including the 7.5% solution, represents a safe and evidence-based component of modern infection control strategies in invasive gynecology.

Abstract licence: CC BY-NC-ND

Abstract Objectives/Hypothesis: To assess the efficacy of 0.23% povidone-iodine (PVP-I) nasal rinses and mouth washes on detectability of the coronavirus disease 2019 (COVID-19) virus and cycle threshold (Ct) values in nasopharyngeal swabs. Study Design: This was an open-label, prospective, randomized, placebo-controlled clinical trial. Setting: The study was conducted in King Saud University Medical City, Riyadh, Saudi Arabia, from August 2021 to July 2022. Methods: Participants diagnosed with SARS-CoV-2 were randomly assigned to one of three groups, with participants receiving either 0.23% PVP-I, 0.9% normal saline (NS) nasal rinses and mouth washes, or no intervention (control group). Nasopharyngeal swabs were taken 4, 8, 12, and 18 days after the first swab to measure the detectability of the virus and the Ct. Results: A total of 19 participants were involved in this study. The mean viral survival was 9.8, 12, and 12.6 days for the PVP-I, NS, and control groups, respectively, with a statistically significant difference (p = 0.046). The Ct mean values were 23 ± 3.4, 23.5 ± 6.3, and 26.3 ± 5.9 at the time of recruitment and 25.2 ± 3.5, 15 ± 11.7, and 26.9 ± 6.4 after 4 days for the PVP-I, NS, and control groups, respectively. Conclusions: When used continuously at a concentration of 0.23%, PVP-I showed promising results in terms of decreasing the pandemic burden by reducing the period of infectiousness and viral load. However, the use of PVP-I did not result in significantly different changes in the quality-of-life parameters in recently vaccinated and mild COVID-19 patients.

Abstract licence: CC BY 4.0

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert's workshop on resistance and MRSA decolonization. Compared to chlorhexidine and mupirocin, respectively, PVP-I 10 and 7.5% solutions demonstrated rapid and superior bactericidal activity against MRSA in in vitro and ex vivo studies. Notably, PVP-I 10 and 5% solutions were also active against both chlorhexidine-resistant and mupirocin-resistant strains, respectively. Unlike chlorhexidine and mupirocin, available reports have not observed a link between PVP-I and the induction of bacterial resistance or cross-resistance to antiseptics and antibiotics. These preclinical findings also translate into clinical decolonization, where intranasal PVP-I significantly improved the efficacy of chlorhexidine wash and was as effective as mupirocin in reducing surgical site infection in orthopedic surgery. Overall, these qualities of PVP-I make it a useful alternative decolonizing agent for the prevention of S. aureus infections, but additional experimental and clinical data are required to further evaluate the use of PVP-I in this setting.

Abstract licence: CC BY

This is a case of 11 years-old patient diagnosed of suppurative osteomyelitis of the right maxilla. He had incision and drainage with sequestrectomy under general anaesthesia, and povidone-iodine-impregnated antra pack. About 60 hours after surgery, patient began to have seizures, about 6 episodes on the first night, generalized, tonic-clonic, each lasting about 1 minute with post-ictal vomiting. An initial assessment of meningitis (to rule out cerebral abscess) was made. The seizure episodes which lasted for 3 days began to reduce gradually, and completely subsided 24 hours after the removal of the antra pack. However, when the patient had a CT scan with iodine-based contrast as requested by the paediatric neurologist (to rule out cerebral abscess), the episodes went up significantly again for another 24 hours, after which it began to reduce, till none was recorded 48 hours after contrast administration. Povidone-Iodine (PVI) slowly liberates free iodine to exhibit its broad range of microbicidal activity. However, depending on the amount of iodine absorbed, there is a possibility of iodine toxicity, with different systemic manifestations including seizures, especially in children. The seizure is believed to be a result of disruption in the blood-brain barrier by free iodine from PVI and the iodine-based contrast media. Therefore caution should be taken in using PVI as an antiseptic agent in antra packs or on any mucosa surface, especially in children.  

Abstract licence: CC BY 4.0