Povidone-Iodine 4% shampoo

PurposeWhile povidone-iodine (PI) is a commonly used antiseptic solution for postinjection endophthalmitis (PIE) prophylaxis, chlorhexidine (CHX) may be better tolerated by patients. This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of CHX and PI for PIE prophylaxis.DesignSystematic Review and Meta-Analysis.MethodsMEDLINE, Embase, and the Cochrane Library were systematically searched for relevant literature from January 2000 to July 2024. Studies that compared CHX with PI for either PIE prophylaxis, functional outcomes, or safety outcomes were included. A random-effects meta-analysis was performed, using the Mantel-Haenszel method for dichotomous outcomes and inverse variance method for continuous outcomes. The primary outcomes were the comparative PIE incidence after CHX versus PI. Secondary outcomes pertained to best-corrected visual acuity (BCVA), patient intolerance, pain, safety endpoints, and specimens cultured.ResultsA total of seven studies were included. The incidence of presumed PIE (nCHX = 60/185,849, 0.032% vs nPI = 69/269,491, 0.026%), culture-positive PIE (nCHX = 30/185,849 0.016% vs nPI = 24/269,491, 0.009%; odds ratio [OR] = 2.03, 95% confidence interval [CI] = [0.74, 5.58], P = .17) and culture-negative PIE (nCHX = 30/185,849, 0.016% vs nPI = 45/269,491, 0.017%; OR = 0.97, 95% CI = [0.45, 2.06], P = .93) were nonsignificantly different between PI and CHX groups. No significant risk differences were observed for these outcomes. Across three studies reporting on 54 eyes with culture-positive endophthalmitis, the odds of having positive Staphylococcus epidermidis cultures were significantly lower in the CHX group (nCHX = 9/30, 30.0% vs nPI = 18/24, 75.0%; OR = 0.15, 95% CI = [0.04, 0.54], P = .004); however, the odds were nonsignificantly different for Staphylococcus aureus (P = .64), Streptococcus viridans (P = .46), Streptococcus mitis (P = .83), and Enterococcus faecalis (P = .46). In cases of endophthalmitis, the mean BCVA was nonsignificantly different between CHX and PI groups at the last study observation (P = .67). The systematic review revealed minimal patient intolerance to CHX, more favorable reductions in pain with CHX than PI, greater corneal epitheliopathy with PI than CHX, and nonsignificantly different reductions in ocular surface microbial isolates between comparators.ConclusionsCHX and PI were associated with nonsignificantly different rates of presumed, culture-positive, and culture-negative PIE. Endophthalmitis cases associated with both antiseptic agents had a comparable prognosis with respect to BCVA. However, CHX exhibited a more favorable safety and pain profile compared to PI and was associated with a lower odds of positive S. epidermidis cultures in endophthalmitis cases.

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ImportanceIntravascular catheters are essential in health care but remain a major source of health care-associated infections. Optimal skin antisepsis before insertion is key, yet the most effective antiseptic agent, concentration, and formulation remain uncertain.ObjectiveTo determine the concentration and formulation of chlorhexidine gluconate (CHG) or povidone-iodine (PVI) associated with the lowest incidence of catheter-related infections (CRIs).Data sourcesPubMed, EMBASE, Cochrane Central, Scopus, Web of Science, and CINAHL were searched through January 7, 2025, without restrictions. Trial registries and reference lists of relevant studies and guidelines were reviewed.Study selectionRandomized clinical trials (RCTs) comparing CHG- or PVI-based skin antisepsis before insertion of intravascular catheters were eligible if they reported at least 1 CRI outcome (catheter-related bloodstream infection [CRBSI], catheter tip colonization, or local infection). Two independent reviewers screened titles, abstracts, and full texts.Data extraction and synthesisData were extracted independently by 2 reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed with the Cochrane risk of bias 2 tool. A random-effects network meta-analysis (NMA) was performed to estimate relative risks (RRs) with 95% CIs.Main outcomes and measuresThe primary outcomes were incidence of CRBSIs, catheter tip colonization, and local infections associated with CHG or PVI formulations.ResultsSixteen RCTs (7803 patients; 11 985 catheters) met inclusion criteria. When compared with aqueous formulations, alcohol-based formulations were consistently associated with lower infections rates, with isopropyl alcohol being superior to ethanol. Compared with alcoholic PVI, alcoholic CHG was associated with lower CRBSIs (RR, 0.70 [95% CI, 0.45 to 1.08]), catheter tip colonizations (RR, 0.42 [95% CI, 0.37 to 0.48]), and local infections (RR, 0.40 [95% CI, 0.23 to 0.70]). High concentration CHG (1% or higher) further lowered CRBSIs (RR, 0.31 [95% CI, 0.19 to 0.52]) and colonization (RR, 0.36 [95% CI, 0.30 to 0.42]) compared with lower concentrations. Local adverse events were uncommon, slightly more frequent with alcohol-based formulations, and similar between CHG and PVI.Conclusions and relevanceIn this NMA of RCTs, high concentration CHG in isopropyl alcohol was associated with the lowest incidence of CRIs. These results suggest that alcoholic PVI and aqueous formulations should be reserved for situations in which CHG or alcohol cannot be used.

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