Abstract
The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.
Full text
PDF










Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bird G. G., Bunch G. A., Croft C. B., Hoffmann D. C., Humphrey C. S., Rhind J. R., Rosenberg I. L., Whittaker M., Wilkinson A. R., Hall R. Topical noxythiolin antisepsis. Report of a controlled trial. Br J Surg. 1971 Jun;58(6):447–448. doi: 10.1002/bjs.1800580611. [DOI] [PubMed] [Google Scholar]
- Browne M. K., Stoller J. L. Intraperitoneal noxythiolin in faecal peritonitis. Br J Surg. 1970 Jul;57(7):525–529. doi: 10.1002/bjs.1800570711. [DOI] [PubMed] [Google Scholar]
- Calman K. C., Kennedy F., Meudell C. M., Sleigh J. D. Prophylaxis of wound infection. Br Med J. 1971 Oct 23;4(5781):232–232. doi: 10.1136/bmj.4.5781.232-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crosfill M., Hall R., London D. The use of chlorhexidine antisepsis in contaminated surgical wounds. Br J Surg. 1969 Dec;56(12):906–908. doi: 10.1002/bjs.1800561209. [DOI] [PubMed] [Google Scholar]
- Davidson A. E., Clark C., Smith G. Postoperative wound infection: a computer analysis. Br J Surg. 1971 May;58(5):333–337. doi: 10.1002/bjs.1800580504. [DOI] [PubMed] [Google Scholar]
- Davidson A. I., Smith G., Smylie H. G. A bacteriological study of the immediate environment of a surgical wound. Br J Surg. 1971 May;58(5):326–333. doi: 10.1002/bjs.1800580503. [DOI] [PubMed] [Google Scholar]
- Desai S., Jamieson C. W. Intraperitoneal noxytiolin as an experimental chemotherapeutic agent. Br J Surg. 1973 May;60(5):350–351. doi: 10.1002/bjs.1800600506. [DOI] [PubMed] [Google Scholar]
- Dillon M. L., Postlethwait R. W., Bowling K. A. Operative wound cultures and wound infections: a study of 342 patients. Ann Surg. 1969 Dec;170(6):1029–1034. doi: 10.1097/00000658-196912000-00025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fraser-Moodie A. Prevention of wound infections after appendicectomy: a trial of two procedures. J R Coll Surg Edinb. 1974 Mar;19(2):121–123. [PubMed] [Google Scholar]
- GERSHENFELD L. Povidone-iodine as a topical antiseptic. Am J Surg. 1957 Dec;94(6):938–939. doi: 10.1016/0002-9610(57)90086-7. [DOI] [PubMed] [Google Scholar]
- Gilmore O. J., Martin T. D. Aetiology and prevention of wound infection in appendicetomy. Br J Surg. 1974 Apr;61(4):281–287. doi: 10.1002/bjs.1800610407. [DOI] [PubMed] [Google Scholar]
- Gilmore O. J., Reid C. Noxytiolin and peritoneal adhesion formation. Br J Surg. 1976 Dec;63(12):978–980. doi: 10.1002/bjs.1800631224. [DOI] [PubMed] [Google Scholar]
- Gilmore O. J., Sanderson P. J. An antibiotic policy for surgical patients. Ann R Coll Surg Engl. 1975 Oct;57(4):204–211. [PMC free article] [PubMed] [Google Scholar]
- Gilmore O. J., Sanderson P. J. Prophylactic interparietal povidone-iodine in abdominal surgery. Br J Surg. 1975 Oct;62(10):792–799. doi: 10.1002/bjs.1800621011. [DOI] [PubMed] [Google Scholar]
- Goligher J. C., Graham N. G., De Dombal F. T. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg. 1970 Feb;57(2):109–118. doi: 10.1002/bjs.1800570208. [DOI] [PubMed] [Google Scholar]
- Goto M., Kataoka Y., Kimura T., Goto K., Sato H. Decrease of saturation density of cells of hamster cell lines after treatment with dextran sulfate. Exp Cell Res. 1973 Dec;82(2):367–374. doi: 10.1016/0014-4827(73)90354-6. [DOI] [PubMed] [Google Scholar]
- HARBISON S. P. FRAGMENTATION. Arch Surg. 1964 Jul;89:1–6. doi: 10.1001/archsurg.1964.01320010003001. [DOI] [PubMed] [Google Scholar]
- Hawley P. R. Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum. 1973 Jul-Aug;16(4):272–277. doi: 10.1007/BF02587700. [DOI] [PubMed] [Google Scholar]
- Houang E. T., Gilmore O. J., Reid C., Shaw E. J. Absence of bacterial resistance to povidone iodine. J Clin Pathol. 1976 Aug;29(8):752–755. doi: 10.1136/jcp.29.8.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Irvin T. T., Hunt T. K. Pathogenesis and prevention of disruption of colonic anastomoses in traumatized rats. Br J Surg. 1974 Jun;61(6):437–439. doi: 10.1002/bjs.1800610605. [DOI] [PubMed] [Google Scholar]
- King D. W., Gurry J. F., Brooke B. N. The effect of noxytiolin in experimental peritonitis. Br J Surg. 1975 Aug;62(8):645–646. doi: 10.1002/bjs.1800620816. [DOI] [PubMed] [Google Scholar]
- LJUNGQVIST U. WOUND SEPSIS AFTER CLEAN OPERATIONS. Lancet. 1964 May 16;1(7342):1095–1097. doi: 10.1016/s0140-6736(64)91291-7. [DOI] [PubMed] [Google Scholar]
- Lavelle K. J., Doedens D. J., Kleit S. A., Forney R. B. Iodine absorption in burn patients treated topically with povidone-iodine. Clin Pharmacol Ther. 1975 Mar;17(3):355–362. doi: 10.1002/cpt1975173355. [DOI] [PubMed] [Google Scholar]
- Lavigne J. E., Brown C. S., Machiedo G. W., Blackwood J. M., Rush B. F., Jr The treatment of experimental peritonitis with intraperitoneal betadine solution. J Surg Res. 1974 Apr;16(4):307–311. doi: 10.1016/0022-4804(74)90047-x. [DOI] [PubMed] [Google Scholar]
- Levin J., Poore T. E., Young N. S., Margolis S., Zauber N. P., Townes A. S., Bell W. R. Gram-negative sepsis: detection of endotoxemia with the limulus test. With studies of associated changes in blood coagulation, serum lipids, and complement. Ann Intern Med. 1972 Jan;76(1):1–7. doi: 10.7326/0003-4819-76-1-1. [DOI] [PubMed] [Google Scholar]
- Lister J. On the Antiseptic Principle in the Practice of Surgery. Br Med J. 1867 Sep 21;2(351):246–248. doi: 10.1136/bmj.2.351.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MUSSGNUG G. Verhütung von intraabdominellen Verwachsungen mit Periston N (Kollidon). Chirurg. 1956 Dec;27(12):543–545. [PubMed] [Google Scholar]
- Mackie B., Shafi M. S., Grundy D. J., Ralphs D. N., Haynes S. Topical ampicillin and noxythiolin antisepsis in appendicectomy wounds. Br J Clin Pract. 1973 Feb;27(2):57–61. [PubMed] [Google Scholar]
- McQuillen M. P., Cantor H. E., O'Rourke J. R. Myasthenic syndrome associated with antibiotics. Arch Neurol. 1968 Apr;18(4):402–415. doi: 10.1001/archneur.1968.00470340088008. [DOI] [PubMed] [Google Scholar]
- Pietsch J., Meakins J. L. Complications of povidone-iodine absorption in topically treated burn patients. Lancet. 1976 Feb 7;1(7954):280–282. doi: 10.1016/s0140-6736(76)91406-9. [DOI] [PubMed] [Google Scholar]
- SCHATTEN W. E. Intraperitoneal antibiotic administration in the treatment of acute bacterial peritonitis. Surg Gynecol Obstet. 1956 Mar;102(3):339–346. [PubMed] [Google Scholar]
- SHELANSKI H. A., SHELANSKI M. V. PVP-iodine: history, toxicity and therapeutic uses. J Int Coll Surg. 1956 Jun;25(6):727–734. [PubMed] [Google Scholar]
- Schrock T. R., Deveney C. W., Dunphy J. E. Factor contributing to leakage of colonic anastomoses. Ann Surg. 1973 May;177(5):513–518. doi: 10.1097/00000658-197305000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- UPPLEGGER H. Die Verhütung von Bauchfelladhäsionen durch Kollidon. Chirurg. 1956 Aug;27(8):365–367. [PubMed] [Google Scholar]
