Povidone-iodine

Overview

Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may also be used for minor wounds. It may be applied to the skin as a liquid, an ointment or a powder.[1][2][3] WP

Side effects include skin irritation and sometimes swelling. If used on large wounds, kidney problems, high blood sodium, and metabolic acidosis may occur. It is not recommended for use in pregnant women who are under 32 weeks’ gestation. Frequent use is not recommended in people with thyroid problems or who are taking lithium.[1][2] WP

Povidone-iodine is a chemical complex of povidone, hydrogen iodide, and elemental iodine. The recommended strength solution contains 10% Povidone, with total iodine species equaling 10,000 ppm or 1% total titratable iodine. It works by releasing iodine which results in the death of a range of microorganisms.[1][4] WP

Povidone-iodine came into commercial use in 1955. It is on the World Health Organization's List of Essential Medicines. Povidone-iodine is available over the counter. It is sold under a number of brand names including Betadine.[2][3][5][6] WP

Uses, dosage and effects

Medical uses

Povidone-iodine is a broad spectrum antiseptic for topical application in the treatment and prevention of wound infection. It may be used in first aid for minor cuts, burns, abrasions and blisters. Povidone-iodine exhibits longer lasting antiseptic effects than tincture of iodine, due to its slow absorption through soft tissue, making it the choice for longer surgeries. Chlorhexidine is almost twice as effective in preventing infection after surgery with a similar to lower risk of adverse events, and the combination of sodium hypochlorite and hypochlorous acid in very low concentration is significantly superior for wound healing.[7][8][9] WP

Consequently, PVP-I has found broad application in medicine as a surgical scrub; for pre- and post-operative skin cleansing; for the treatment and prevention of infections in wounds, ulcers, cuts and burns; for the treatment of infections in decubitus ulcers and stasis ulcers; in gynecology for vaginitis associated with candidal, trichomonal or mixed infections. For these purposes PVP-I has been formulated at concentrations of 7.5–10.0% in solution, spray, surgical scrub, ointment, and swab dosage forms; however, use of 10% povidone-iodine though recommended, is infrequently used, as it is poorly accepted by health care workers and is excessively slow to dry.[10][11] WP

Because of these critical indications, only sterile povidone-iodine should be used in most cases. Non-sterile product can be appropriate in limited circumstances in which people have intact, healthy skin that will not be compromised or cut. The non-sterile form of Povidone iodine has a long history of intrinsic contamination with Burkholderia cepacia (Pseudomonas cepacia), and other opportunistic pathogens. Its ability to harbor such microbes further underscores the importance of using sterile products in any clinical setting. Since these bacteria are resistant to povidone iodine, statements that bacteria do not develop resistance to PVP-I, should be regarded with great caution: some bacteria are intrinsically resistant to a range of biocides including povidone-iodine.[12][13] WP⚠ Part of this sentence could not be copied from the source. Open the source to read it in full.

Eyes

A buffered PVP-I solution of 2.5% concentration can be used for prevention of neonatal conjunctivitis, especially if it is caused by Neisseria gonorrhoeae, or Chlamydia trachomatis. It is unclear whether PVP-I is more effective in reducing the number of cases of conjunctivitis in neonates over other methods. PVP-I appears to be very suitable for this purpose because, unlike other substances, it is also efficient against fungi and viruses (including HIV and Herpes simplex).[14][15] WP

Pleurodesis

It is used in pleurodesis (fusion of the pleura because of incessant pleural effusions). For this purpose, povidone-iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.[16] WP

Vagina

Vaginal suppositories can be used for treatment of bacterial vaginosis.[17] WP

Alternatives

There is strong evidence that chlorhexidine and alcohol used to clean skin prior to surgery is better than any formulation of povidone-iodine.[7] WP

While the 2016 World Health Organization guidelines recommended alcohol-based CHG Chlorhexidine for surgical skin preparation based on low-to-moderate quality evidence, subsequent clinical data has clarified this comparison. A large-scale 2024 non-inferiority trial involving over 3,300 patients undergoing cardiac or abdominal surgeries found that alcohol-based povidone-iodine is non-inferior to alcohol-based CHG Chlorhexidine in preventing surgical site infections (SSIs).[18] WP

Risks and side effects

Contraindications

PVP-I is contraindicated in people with hyperthyroidism (overactive thyroid gland) and other diseases of the thyroid, after treatment with radioiodine, and in people with dermatitis herpetiformis (Duhring's disease).[19] WP

Side effects

The sensitization rate to the product is 0.7%.[20] WP

Interactions

Interactions

The iodine in PVP-I reacts with hydrogen peroxide, silver, taurolidine and proteins such as enzymes, rendering them (and itself) ineffective. It also reacts with many mercury compounds, giving the corrosive compound mercury iodide, as well as with many metals, making it unsuitable for disinfecting metal piercings.[19] WP

Iodine is absorbed into the body to various degrees, depending on application area and condition of the skin. As such, it interacts with diagnostic tests of the thyroid gland such as radioiodine diagnostics, as well as with various diagnostic agents used on the urine and stool, for example Guaiacum resin.[19] WP

Research

Research

Povidone-iodine has found application in the field of nanomaterials. A wound-healing application has been developed which employs a mat of single wall carbon nanotubes (SWNTs) coated in a monolayer of povidone-iodine.[21][22] WP

Research has previously found that the polymer polyvinylpyrrolidone (PVP, povidone) can coil around individual carbon nanotubes to make them water-soluble.[23] WP

History

History

Following the discovery of iodine by Bernard Courtois in 1811, it has been broadly used for the prevention and treatment of skin infections, as well as the treatment of wounds. Iodine has been recognized as an effective broad-spectrum bactericide, and is also effective against yeasts, molds, fungi, viruses, and protozoans. Drawbacks to its use in the form of aqueous solutions include irritation at the site of application, toxicity, and the staining of surrounding tissues. These deficiencies were overcome by the discovery and use of PVP-I, in which the iodine is carried in a complexed form and the concentration of free iodine is very low. The product thus serves as an iodophor. WP

PVP-I was discovered in 1955, at the Industrial Toxicology Laboratories in Philadelphia by H. A. Shelanski and M. V. Shelanski. They carried out tests in vitro to demonstrate anti-bacterial activity, and found that the complex was less toxic in mice than tincture of iodine. Human clinical trials showed the product to be superior to other iodine formulations.[24][25] WP

Chemistry

Formula

C6H9I2NO PC

CAS number

25655-41-8 PC

Molar mass (g/mol)

364.95 PC

IUPAC name (computed by PubChem)

1-ethenylpyrrolidin-2-one;molecular iodine PC

SMILES

C=CN1CCCC1=O.II PC

InChIKey

CPKVUHPKYQGHMW-UHFFFAOYSA-N PC

PubChem CID

410087

IUPAC name

2-Pyrrolidinone, 1-ethenyl-, homopolymer WP

Harm reduction information

No harm reduction data is on file for this compound yet. That means no dose, timing or combination data from PsychonautWiki or TripSit. Please don't guess a dose from similar compounds. If you have taken it and feel unwell, contact emergency services or a poison control center.

User reports

Pop culture

No references added yet.

Sources

1. Other World Health Organization. WHO Model Formulary 2008. 2009
2. Other British National Formulary (BNF), 69th Edition. 6 March 2015
3. Other Povidone iodine topical Uses, Side Effects & Warnings
4. Other Encyclopedia of polymer science and technology. 16 October 2013
5. Other Sneader W. Drug Discovery: A History. 31 October 2005
6. Other World Health Organization. World Health Organization model list of essential medicines: 22nd list (2021). 2021
7. Journal / agency Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O. The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Annals of Surgery. September 2020. doi:10.1097/SLA.0000000000004076 · PMID 32773627
8. Journal / agency Chen S, Chen JW, Guo B, Xu CS. Preoperative Antisepsis with Chlorhexidine Versus Povidone-Iodine for the Prevention of Surgical Site Infection: a Systematic Review and Meta-analysis. World Journal of Surgery. May 2020. doi:10.1007/s00268-020-05384-7 · PMID 31996985
9. Journal / agency Kramer A, Dissemond J, Kim S, Willy C, Mayer D, Papke R, Tuchmann F, Assadian O. Consensus on Wound Antisepsis: Update 2018. Skin Pharmacology and Physiology. 2018. doi:10.1159/000481545 · PMID 29262416
10. Journal / agency Slater K, Cooke M, Fullerton F, Whitby M, Hay J, Lingard S, Douglas J, Rickard CM. Peripheral intravenous catheter needleless connector decontamination study-Randomized controlled trial. American Journal of Infection Control. September 2020. doi:10.1016/j.ajic.2019.11.030 · PMID 31928890
11. Journal / agency Slater K, Fullerton F, Cooke M, Snell S, Rickard CM. Needleless connector drying time-how long does it take?. American Journal of Infection Control. September 2018. doi:10.1016/j.ajic.2018.05.007 · PMID 29880433
12. Journal / agency Fleischer W, Reimer K. Povidone-iodine in antisepsis--state of the art. Dermatology. 1997. doi:10.1159/000246022 · PMID 9403248
13. Journal / agency Rose H, Baldwin A, Dowson CG, Mahenthiralingam E. Biocide susceptibility of the Burkholderia cepacia complex. The Journal of Antimicrobial Chemotherapy. March 2009. doi:10.1093/jac/dkn540 · PMID 19153076 · PMC2640157
14. Journal / agency Martin I, Sawatzky P, Liu G, Mulvey MR. Neisseria gonorrhoeae in Canada: 2009-2013. Canada Communicable Disease Report. February 2015. doi:10.1002/14651858.CD001862.pub3 · PMC6457593
15. Journal / agency Najafi Bi R, Samani SM, Pishva N, Moheimani F. Formulation and Clinical Evaluation of Povidone-Iodine Ophthalmic Drop. Iranian Journal of Pharmaceuticical Research. 2003
16. Journal / agency Agarwal R, Khan A, Aggarwal AN, Gupta D. Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis. The Indian Journal of Medical Research. March 2012. PMID 22561614 · PMC3361864
17. Journal / agency Wewalka G, Stary A, Bosse B, Duerr HE, Reimer K. Efficacy of povidone-iodine vaginal suppositories in the treatment of bacterial vaginosis. Dermatology. 2002. doi:10.1159/000057731 · PMID 12011527
18. Journal / agency Maiwald M, Widmer AF. WHO's recommendation for surgical skin antisepsis is premature. The Lancet. Infectious Diseases. October 2017. doi:10.1016/S1473-3099(17)30448-6 · PMID 28948925
19. Other Austria-Codex. 2007
20. Journal / agency Niedner R. Cytotoxicity and sensitization of povidone-iodine and other frequently used anti-infective agents. Dermatology. 1997. doi:10.1159/000246038 · PMID 9403263
21. Journal / agency Makhayeva DN, Irmukhametova GS, Khutoryanskiy VV. Advances in antimicrobial polymeric iodophors. European Polymer Journal. 8 November 2023. doi:10.1016/j.eurpolymj.2023.112573
22. Journal / agency Simmons T, Lee S, Park T, Hashim D, Ajayan P, Linhardt R. Antiseptic single wall carbon nanotube bandages. Carbon. 2009. doi:10.1016/j.carbon.2009.02.005
23. Journal / agency Simmons TJ, Hashim D, Vajtai R, Ajayan PM. Large area-aligned arrays from direct deposition of single-wall carbon nanotube inks. Journal of the American Chemical Society. August 2007. doi:10.1021/ja073745e · PMID 17663555
24. Other U.S. patent 2739922
25. Other Walter S. Drug Discovery: A History. 23 June 2005

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