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Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy.

Abstract

BACKGROUND

The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema.

OBJECTIVES

To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers.

PATIENTS AND METHODS

63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection.

RESULTS

Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%).

CONCLUSION

Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas).

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Dermatology and Lymphology, St. Stephan Hospital, Budapest, Hungary. h13527dar@helka.iif.hu

    Source

    Dermatology (Basel, Switzerland) 212 Suppl 1: 2006 pg 82-7

    MeSH

    Aged
    Amoxicillin
    Anti-Bacterial Agents
    Anti-Infective Agents, Local
    Bandages
    Chronic Disease
    Humans
    Middle Aged
    Povidone-Iodine
    Prospective Studies
    Quality Control
    Recurrence
    Staphylococcal Infections
    Staphylococcus aureus
    Treatment Outcome
    Varicose Ulcer
    Wound Healing
    Wound Infection

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    16490980

    Citation

    Daróczy, Judit. "Quality Control in Chronic Wound Management: the Role of Local Povidone-iodine (Betadine) Therapy." Dermatology (Basel, Switzerland), vol. 212 Suppl 1, 2006, pp. 82-7.
    Daróczy J. Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy. Dermatology (Basel). 2006;212 Suppl 1:82-7.
    Daróczy, J. (2006). Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy. Dermatology (Basel, Switzerland), 212 Suppl 1, pp. 82-7.
    Daróczy J. Quality Control in Chronic Wound Management: the Role of Local Povidone-iodine (Betadine) Therapy. Dermatology (Basel). 2006;212 Suppl 1:82-7. PubMed PMID: 16490980.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy. A1 - Daróczy,Judit, PY - 2006/2/24/pubmed PY - 2006/6/23/medline PY - 2006/2/24/entrez SP - 82 EP - 7 JF - Dermatology (Basel, Switzerland) JO - Dermatology (Basel) VL - 212 Suppl 1 N2 - BACKGROUND: The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema. OBJECTIVES: To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers. PATIENTS AND METHODS: 63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection. RESULTS: Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%). CONCLUSION: Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas). SN - 1018-8665 UR - https://www.unboundmedicine.com/medline/citation/16490980/Quality_control_in_chronic_wound_management:_the_role_of_local_povidone_iodine__Betadine__therapy_ L2 - https://www.karger.com?DOI=10.1159/000089204 DB - PRIME DP - Unbound Medicine ER -