Evaluation of the tissue toxicity of antiseptics by the hen's egg test on the chorioallantoic membrane (HETCAM) (original) (raw)
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The use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause of delayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewer systemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided into three groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore, this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, their disadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activity than antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still many adverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects of commonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin, mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, the antimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awareness for antimicrobial selection in those populations.
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The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.
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Currently, there is no agreed standard for exploring the antimicrobial activity of wound antiseptics in a phase 2/ step 2 test protocol. In the present study, a standardised in-vitro test is proposed, which allows to test potential antiseptics in a more realistically simulation of conditions found in wounds as in a suspension test. Furthermore, factors potentially influencing test results such as type of materials used as test carrier or various compositions of organic soil challenge were investigated in detail. This proposed phase 2/ step 2 test method was modified on basis of the EN 14561 by drying the microbial test suspension on a metal carrier for 1 h, overlaying the test wound antiseptic, washing-off, neutralization, and dispersion at serial dilutions at the end of the required exposure time yielded reproducible, consistent test results. The difference between the rapid onset of the antiseptic effect of PVP-I and the delayed onset especially of polihexanide was apparent. Among...
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Bacterial colonization and infection are important factors in compromised wound healing, particularly in chronic wounds. Although "best practice" for controlling these factors currently is not defined, systemic antibiotics are generally accepted as the preferred choice for treating infection, provided ischemia does not reduce their bioavailability. However, widespread use of systemic and topical antibiotics is associated with the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem--potentially delayed healing and a potential source for cross-contamination. The judicious use of dressings, notably those containing certain antiseptic agents, can be a valuable option to control infection and promote healing. A review of the literature underscores the importance of considering the antiseptic route as part of a concerted approach to wound management and infection control.
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Topical antiseptics are a diverse group of agents that are widely used in medicine for the antimicrobial properties. Despite their long history and broad application, caution must be exercised in their use, especially in the pediatric age group, as various cutaneous reactions ranging from hypersensitivity to urticarial to skin necrosis have been reported. The use of topical antiseptics in pediatrics has also been associated with systemic reactions, which depend on the antiseptic in question. Antiseptics such as chlorhexidine, povidon iodine, methylene blue, gentian violet, silver nitrate, boric acid, Castellani solution, alcohol and chloramines have been reviewed. It is essential that physicians bear in mind the possible adverse effects that may follow topical antiseptic use, as this facilitates prevention and also timely intervention if, and when, they occur.
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Chronic wounds will heal in most cases if provided an optimal local wound environment and therapy that addresses underlying disease. The quality of topical wound management will influence the speed of the wound healing process. The value of cleansing chronic wounds is considered a basic principle in modern wound management. Several methods are available for wound cleansing and debridement. Currently, there has been focus on measures of wound cleansing whereby debris and exudate are gently and continuously removed to prepare the wound bed for wound closure. For this purpose, physiological solutions or specific disinfectants may be used. This retrospective analysis of existing data was performed looking at the clinical efficacy and cost-effectiveness of using a wound antiseptic to treat problem wounds. Wound cleansing upon dressing changes using a polyhexanide containing solution (Prontosan®, B Braun, Melsungen AG, Germany) in venous leg ulcers was compared to cleansing with eithe...