About the use of the drug "Betadine" in surgical practice

Contraindications

hypersensitivity to iodine and other components of the drug;

dysfunction of the thyroid gland (hyperthyroidism) (see “Special instructions”);

thyroid adenoma;

Dühring's dermatitis herpetiformis;

simultaneous use of radioactive iodine;

premature and newborn babies (see “Special instructions”).

With caution: pregnancy and lactation, chronic renal failure.

The use of Betadine® is not recommended from the 3rd month of pregnancy and during lactation. If necessary, in these cases, treatment is possible under individual medical supervision.

About the use of the drug "Betadine" in surgical practice

Ershova A.K.

Currently, the incidence of infectious wound complications in surgical practice is not decreasing, despite the introduction of new, modern methods of prevention and treatment. The success of a well-performed complex surgical operation is negated by the development of postoperative purulent complications. And the increase in cases of generalization of infection and toxic-allergic reactions not only complicates treatment, but also leads to a significant increase in the time of hospital stay and an increase in the cost of treating patients [1]. Therefore, the correct choice of an antiseptic is important not only from the point of view of effective treatment of purulent diseases and their complications, but also taking into account pharmaco-economic aspects.

In more than 60% of cases, surgical wound infections are caused by 7 types of bacteria: 19% - Escherichia coli, 18.3% - Staphylococcus aureus, 8.8% - Proteus spp., 8.7% - Pseudomonas aeruginosa, 3.9% - Bacteroides spp., 2.6% – Streptococcus spp., 1.1% – Clostridium perfringens [2]. Infectious complications in surgical hospitals develop most often in the area of ​​the surgical incision; Also, do not forget about post-injection, catheter-associated infections [3] and purulent complications, which are often encountered in the formation of bedsores.

To solve the problem of infectious complications in surgery, it is necessary first of all to influence the causative agent of the infection. The leading role in this, undoubtedly, is occupied by antibiotic therapy, which, in connection with the development and improvement of bacteriological diagnostic methods, should ideally be based on the accurate isolation and identification of microorganisms, especially when it comes to nosocomial pathogens. Another important aspect in the prevention and treatment of infectious complications in a surgical hospital is local treatment using local forms of antibiotics and local antiseptics.

Local antiseptics are divided into eleven main groups: 1 - group of halogens, including iodine preparations, 2 - oxidizing agents, 3 - acids, 4 - aldehydes, 5 - phenols, 6 - alcohols, 7 - hypertonic solutions, 8 - dyes, 9 – salts of heavy metals, 10 – detergents and 11 – nitrofuran derivatives. An important feature of modern infection is the presence of several pathogens, both aerobic and anaerobic [4], often resistant to most antibiotics. Resistance to many antiseptic drugs has also become increasingly common [5,6].

Currently, a large number of antiseptic agents are known that have good bactericidal properties [7]. However, recently, research results demonstrate that some strains of microorganisms, especially hospital ones, become resistant to many antiseptics (aqueous solution of chlorhexidine, potassium permanganate solution, furatsilin, etc.). In this regard, an active search is underway for new drugs that reliably prevent the spread of hospital infections. Thus, well-known preparations of iodine, and in particular its various complex compounds, are increasingly used. In this regard, the drug “Betadine” (pharmaceutical, Hungary) deserves special attention. This iodophor is a broad-spectrum antiseptic with bactericidal, sporicidal and antiviral properties [2]. The biologically active substance of the drug is povidone-iodine (in the form of polyvinylpyrrolidone iodine complex), the antimicrobial effect of which is due to oxidative damage and blocking the microorganism cell membrane. Povidone-iodine has been widely used in surgical practice for more than 30 years, starting from the 70–80s of the last century [8,9].

“Betadine” is an antiseptic and disinfectant drug, the antimicrobial effect of which, as mentioned above, is based on iodine damaging the cell wall of pathogenic microorganisms due to the oxidation of amino acids in bacterial proteins containing SH- and OH- groups. These are mainly bacterial enzymes and transmembrane proteins. During oxidation, their quaternary structure changes and they lose their catalytic and enzymatic activity. The compound of iodine with polyvinylpyrrolidone is a synthetic polymer that does not have toxic or antigenic properties, which is capable of reversibly attaching other substances, such as medicinal toxins, drugs, hormones [2]. In combination with polyvinylpyrrolidone, iodine loses its ability to cause tissue burning when applied, but retains high bactericidal activity, which has expanded the scope of its use as an antiseptic. Thanks to the polymer molecule, iodine penetrates deep into the wound, into inflamed tissue and under the scab. "Betadine" has a wide spectrum of antimicrobial action, showing high activity against gram-negative (E. coli, K. pneumoniae, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Proteus spp., Ps. aeruginosa, Salmonella typhi, Shigella spp.), gram-positive microorganisms (Bacillus subtilis, Bacillus subtilis, Clostridium perfringens, Clostridium tetani, Propionibacterium acnes, S. aureus, Str. pyogenes), fungi (Aspergillus niger, Candida albicans, Microsporum audouinii, Nocardia spp., Penicillium spp., Triphophyton spp.), as well as spore-forming flora, protozoa, treponemes, some viruses [9–12]. Particularly important is the fact that, despite the long period of use of povidone-iodine in surgical practice, the most common infectious agents have not acquired resistance to this drug [9,13–15].

Compared to other antiseptics, Betadine has a number of important advantages: it retains antiseptic properties for a long period of time on the skin; retains high antiseptic properties even in the presence of blood and plasma; does not cause the development of resistant forms of microorganisms; highly soluble in water; non-toxic with prolonged and frequent use; rarely causes allergic reactions and is shelf stable.

"Betadine" is indicated for use for the prevention of infectious complications in the following clinical situations [2]:

• treatment of fresh soft tissue wounds;

• treatment of the skin of the surgical field;

• skin treatment before blood collection, biopsy, diagnostic and therapeutic punctures;

• treatment of mucous membranes;

• treatment of “donor” wounds;

• treatment of sutures of postoperative wounds;

• processing of transplants.

As a treatment for infectious complications that have already arisen, Betadine is indicated for use in [16–19]:

• burns;

• purulent postoperative wounds;

• diabetic and atherosclerotic gangrene;

• post-traumatic purulent wounds, osteomyelitis, purulent arthritis;

• trophic ulcers and bedsores;

• washing postoperative chest wounds after open heart surgery;

• treatment of purulent wounds, fistulas due to pacemaker rejection;

• injection into cysts of parenchymal organs.

It is also possible to use povidone-iodine when treating the abdominal cavity after planned and emergency operations and when managing open peritonitis; when treating the pleural cavity after emergency and planned operations for acute and chronic purulent processes, especially in patients with tuberculosis [2].

The most common problem in surgical practice is purulent wounds that occur as a result of complications of traumatic skin injuries, surgical treatment of acute and chronic purulent-inflammatory diseases of soft tissues and bones (phlegmon, abscess, osteomyelitis, etc.) and various other infectious postoperative complications. The course of such wounds is often aggravated by the presence of atherosclerosis of the lower extremities and/or diabetes mellitus, etc. Most often, wound infection occurs in the form of wound suppuration. Clinically, swelling and redness in the affected area, pain on palpation, purulent or serous-purulent discharge, and the presence of necrosis are noted. When a significant volume of soft tissue surrounding the wound is involved in the destructive purulent-inflammatory process, phlegmon occurs [12,20]. In the case of exuding wounds, pyoderma, dermatitis and eczema often develop on the adjacent skin.

In the treatment of various wound processes, the drug "Betadine" has established itself as a highly effective and easy-to-use antiseptic, as was shown in a study by V.V. Michalski et al. [21]. The purpose of this work was to evaluate the effectiveness of the use of the drug "Betadine" in the treatment of patients with wounds of various etiologies. The results of treatment of 114 patients were analyzed, all patients were divided into 2 groups: Group 1 (68 people) – patients in whom Betadine was used in complex therapy. Group 2 (56 people) – patients who used Levomikol ointment for local therapy. Dressings were performed daily. After sanitizing the wound surface with antiseptic solutions, the wound was dried and sterile napkins moistened with Betadine solution or soaked in Betadine ointment were applied to it. As a result of the study, it was shown that when treating wounds with Betadine, a clear regression of the inflammatory process was observed during the first 5–7 days: tissue swelling around the affected area disappeared, the amount of purulent discharge decreased, pain in the wound disappeared or became less intense. When using Betadine, there was a decrease in wound contamination below a critical level, less than 103 CFU/g by 7.2 days, while in the group using the drug Levomikol by 9.9 days, which is due to a wider spectrum of antimicrobial activity " Betadina." When treated with Betadine, a pronounced anti-inflammatory effect was noted, wound cleansing occurred within 2 days. earlier than when using Levomikol (8.1 and 10.2 days, respectively). The appearance of the first granulations was recorded at 10.2 and 13.5 days. The first signs of marginal epithelization in group 1 appeared after 13.9 days, while in group 2 – at 2.6 days. Later. In all cases (n=68), the use of Betadine was not accompanied by the development of side effects. As a result of summarizing all the data obtained, it was demonstrated that wound cleansing when using Betadine occurred faster than in the comparison group.

However, we should not forget about the contraindications to the use of the drug "Betadine", which are:

• hypersensitivity to iodine and other components of the drug;

• hyperthyroidism or other severe thyroid dysfunction (including nodular colloid goiter, endemic goiter, Hashimoto's thyroiditis and thyroid adenoma);

• condition before and after the use of radioactive iodine in the treatment of hyperthyroidism, after scintigraphy with the use of radioiodine (until complete recovery);

• dermatitis (especially Dühring's dermatitis herpetiformis);

• renal failure.

"Betadine" is available in the form of a 10% solution of 30, 120 and 1000 ml (respectively containing 3, 12 and 100 g of a complex compound of iodine with polyvinylpyrrolidone) and 10% ointment of 20 g (containing 2 g of a complex compound of iodine with polyvinylpyrrolidone) .

Thus, modern antiseptic drugs containing povidone-iodine, in particular Betadine, are highly effective in the prevention and treatment of purulent-inflammatory processes in clinical practice. The drug "Betadine" has a wide range of antimicrobial and fungicidal activity and, importantly, is well tolerated by patients with a minimum number of adverse reactions. High clinical and bacteriological effectiveness combined with a high safety profile indicate the need for wider use of the antiseptic drug Betadine in surgical practice.

Literature

1. Belozer A.A., Smirnov O.A., Petkova V.A. Infection control of nosocomial infections in an emergency hospital. Collection of materials of the 3rd Russian scientific and practical conference “Modern problems of epidemiology, diagnosis and prevention of nosocomial infections.” St. Petersburg, 2003; 75–7.

2. Blatun L.A. Modern iodophors are effective drugs for the prevention and treatment of infectious complications. Consilium medicum. 2005, volume 7 no. 1.

3. Lode H. Catheter-associated infections in the ICU. Proceedings of the International Conference “Nosocomial Infections in Intensive Care Units”. 1998; With. 15–6.

4. Kuzin M.I., Kostyuchenok B.M., Kolker I.I. and others. Anaerobic non-clostridial infection in surgery (methodological recommendations). M., 1987; from 29.

5. Goldatein FW et al. S. aureus Strain Largely Resistant to Triclosan: French Study. 44th ICAAC, Washington, 2004.

6. Geissler A, Gerbeaux P, Granier I et al. Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs. Intensive Care Med 2003; 29 (1): 49–54.

7. Langer S, Sedigh Salakdeh M et al. The impact of topical antiseptics on skin microcirculation. Eur J Med Res 2004; 9 (9): 449–54.

8. Surgical infections /Manual edited by I.A. Eryukhina, B.R. Gelfanda, S.A. Shlyapnikov. M. – 2003. – 854 p.

9. L.A. Blatun. Local medicinal treatment of wounds. Problems and new possibilities for solving them // Consilium Medicum. Surgery. – 2007, vol.9. – No. 1.

10. Bulynin V.I., Glukhov A.A., Moshurov I.P. Treatment of wounds. / Voronezh. – 1998. – 248 p. 6.

11. Methodological guidelines for the treatment of wounds: Transl. with him. / Ed. G. Herman. – Medica, 2000. – 123 p. 7.

12. Nazarenko G.I., Sugurova I.Yu., Glyantsev S.P. Wound, bandage, patient. M.: Medicine, 2002. – 472 p.

13. Datsenko B.M. Theory and practice of local treatment of purulent wounds. Problems of drug therapy. – K.: Health, 1995. – 344 p.

14. Osipov I.S., Leonov S.V. Use of the antimicrobial agent "Betadine" in a surgical clinic. M: “Egis” – 1990. – No. 3. – P.7–10.

15. Zamora JL Povidone–iodine and wound infection. // Surgery – 1984, V. 95. – R. 121–122. 15. Zellner PR and Bugyi S. Povidone–iodine in the treatment of burn patients. – //Journal of Hospital Infection, 1985, V. 6. – R. 139–140.

16. Ley R. Traitement local des brulures. Panoplie et therapy. Acta chir Belg 1975; 74 (5): 483–99.

17. Babb JR, Briges K, Jackson DM et al. Topical chemoprophylaxis: Trial in silver phosphate chlorhexidine silver, sulphadiazine and povidone iodine preparations. Burns 1977; 3 (2): 65–71.

18. Stohes EJ, Howand E, Peters JC et al. Comporison of Antibiotic and Antiseptic Prophylaxis of wound infection in Acute Abdominal surgery. World J Surg 1977; 7(6):777–82.

19. Shelling CF. Comparative evalution of pouvidon – iodine aerosol, foam, solution and silver sulfadiazine cream as prophylactic topical antibacterial agents for treatment of the burn wound. Rurns 1980; 7 (2): 143–9.

20. Surgical infections of the skin and soft tissues. Russian national recommendations. / Guide edited by V.S. Savelyeva. M. – 2009. – 89 p.7.

21. Mikhalsky V.V., Goryunov S.V., Bogdanov A.E., Zhilina S.V., Prividentsev A.I., Anikin A.I., Ulyanina A.A. /Use of the drug “Betadine” in the treatment of infected wounds. // Russian medical journal. Surgery. Urology - 2010, v. 18. – No. 29., 1780–1788.

special instructions

In case of dysfunction of the thyroid gland, the use of the drug is possible only under the strict supervision of a doctor.

The use of the drug in newborns is possible only if necessary, after testing the function of the thyroid gland.

Caution should be exercised when used regularly on damaged skin in patients with chronic renal failure.

A colored film is formed at the site of application, which persists until the entire amount of active iodine is released; its disappearance means the cessation of the effect of the drug.

Coloring on leather and fabrics is easily washed off with water.

Do not use for bites from insects, domestic or wild animals.

Avoid getting the drug into your eyes.

Main manifestations of wounds

Pain

In this case, pain occurs due to damage to the nerve endings that were located at the site of the injury. Over time, swelling may increase, which also leads to increased pain. The severity and degree of manifestation of pain depends on factors such as:

• location of the defect, concomitant damage to large nerve trunks;
• type of weapon or conditions of damage (asphalt, garden, bicycle, sharp object, etc.);
• psychological state of the child.

In essence, pain is an adaptive defense reaction of the body.

Bleeding

Any damage to the skin or mucous membranes is in one way or another accompanied by damage to blood vessels (capillaries, arteries, veins). The nature and degree of bleeding depends on the type of damaged vessel. The larger the vessel and the higher the pressure in it, the more massive the bleeding, and vice versa. It is worth highlighting those places on the body that are accompanied by more heavy bleeding: face, head, neck, hands . In these places, the tissues are better supplied with blood. The condition of the blood coagulation system plays an important role. If a child has a minor abrasion or scratch, which is accompanied by prolonged and heavy bleeding, then it is necessary to consult a pediatrician and pediatric hematologist in order to exclude a disease of the blood coagulation system. This may also be indicated by the appearance of a large number of bruises for no reason.

If a small abrasion is accompanied by prolonged and heavy bleeding, then it is necessary to consult a hematologist.

Hiatus

This phenomenon is associated with a reduction in the elastic fibers of the skin. As a result, the skin edges of the lesion diverge. Many surgeons know what Langer's lines are. They indicate the course and direction of the fibrous structures of the skin. For this purpose, incisions are made along these lines, which leads to rapid healing of the incisions and reduction of gaping. Accordingly, when a defect appears perpendicular to these lines, a wide divergence of the edges of the defect develops.

First aid for a child for superficial wounds

When such a situation arises, parents ask themselves: “How to treat the wound? How to properly treat a wound? What is the best remedy for treating a wound?

Before helping a child, parents need to wash their hands with soap and use an antiseptic. Next, in this sequence, you need to follow a number of instructions and actions:

1. Assess the extent and nature of the damage. It is very important to understand whether the baby has a deep or superficial wound.
2. Rinse and stop bleeding. Hydrogen peroxide is best suited for this purpose. You can also use a solution of furatsilin and chlorhexidine.
3. Next, you can treat the skin with a drying antiseptic, for example, iodine solution or brilliant green.
4. Apply an aseptic (clean) dressing.
5. In the future, it is important to change the dressings regularly. It is also possible to use ointments and creams discussed earlier, which will speed up the healing process.

In case of deeper defects, heavy bleeding, wounds that have been bitten and contaminated with soil or old metal, you must urgently contact a surgeon.

Wounds are quite common, especially in young children. The task of parents is to provide timely assistance to the child in order to prevent infection. You must have a minimum first aid kit in your first aid kit. Do not self-medicate and, if threatening injuries occur, consult a doctor.

Types of wounds

They can be:

• Operating: applied deliberately for the purpose of performing an operation.
• Accidental: as a rule, these are household damages.

Depending on the nature and conditions of the damage, wounds are distinguished:

• chopped;
• I stab;
• bruised;
• torn;
• crushed;
• chopped;
• bitten;
• mixed;
• firearms.

In children , cut, puncture, bitten, mixed, and also superficial (abrasions, scratches, etc.) predominate. Particular attention is paid to bites that result from an animal or human bite (for example, another child), as they are the most infected. This is due to the large number of harmful bacteria in the oral cavity. They are most often complicated by infection.

According to the degree of infection there are:

• Freshly infected. As a rule, this damage occurs within 3 days from the date of its application. Defects with soil contamination are especially infected.
• Purulent. An infectious process develops in these lesions. Microbes, when multiplying, lead to increased inflammation, necrosis, and also contribute to the appearance of pus. Children with purulent manifestations develop symptoms of general intoxication: nausea, headache, dizziness, weakness, lethargy.

Wound healing and factors influencing this process

The wound healing process can be disrupted by many factors.

Healing is the process of repairing damaged tissue and restoring its integrity. During the healing process, certain processes occur. We will not dwell on them in more detail, but will only indicate those factors that may disrupt the healing process:

• Age. As a rule, this applies more to older people. The child's body has great regenerative capabilities. This is due to the high level of anabolic (construction) processes in the body.
• Attachment of infection.
• Decreased immunity.
• Poor circulation in the wound area.
• Chronic diseases (diseases of the respiratory and cardiovascular systems, diabetes, tumors and others).

Healing complications

1. Attachment of infection . Most often, a nonspecific purulent infection develops. The threat is tetanus, rabies, diphtheria. Therefore, injuries that have been bitten and contaminated with soil or old metal objects should be immediately examined by a surgeon with a number of preventive measures taken (administration of anti-tetanus serum, rabies vaccine).
2. Bleeding.
3. Divergence of defect edges.
4. In some cases, healing may be complicated by a hypertrophic scar or keloid . They are an abnormal scar that can spread beyond the defect area and also contribute to the development of complications.

Products for treating wounds in children

Below we list the most popular and affordable means for treating superficial wounds in children:

• Iodine. Suitable for superficial abrasions, but not for deeper injuries.
• Diamond green.
• Hydrogen peroxide. It is the drug of choice for first aid in the treatment of superficial abrasions in children. Allows you to clean abrasions and scratches well. An equally important property is stopping bleeding.
• Furacilin. To prepare a solution for topical use, dissolve the tablet in water.
• Miramistin. It is also an antiseptic for topical use. Allows you to prevent suppuration. If a purulent process occurs, it allows you to fight it. A pleasant bonus will be the possibility of using this remedy for acute respiratory viral infections, sore throats and pharyngitis in children.
• Chlorhexidine.

An antiseptic helps prevent suppuration.

To speed up healing, ointments and creams can be used such as:

• Levomekol;
• Betadine;
• Vishnevsky ointment;
• cream Bepanten plus.