Low-Concentration (0.66%) Povidone Iodine Treatment of a Corneal Ulcer in a Rheumatoid Arthritis Patient.
TL;DR: In this paper, the resolution of a peripheral ulcerative keratitis case by means of treatment with 0.66% povidone iodine (3 times/day) given alone for 5 weeks and then associated with serum eyedrops was shown.
Abstract: BACKGROUND Peripheral ulcerative keratitis is one of the ocular complications associated with chronic inflammatory immune-mediated diseases, such as rheumatoid arthritis, in which inflammatory reactions and infections can be recurrent. Suspected infections are treated with topical antibiotics that, in some cases, may promote selection of resistant microbes. Povidone iodine is known for its rapid broad-spectrum activity against all kinds of microbes and biofilms, lack of microbial resistance, ability to counteract excessive inflammation, and efficacy in wound healing, along with an optimum safety and tolerability profile. The purpose of this case report is to show the resolution of a peripheral ulcerative keratitis case by means of treatment with 0.66% povidone iodine. CASE REPORT An 89-year-old woman with rheumatoid arthritis, 1 eye, and a superior descemetic corneal ulcer was treated with amniotic membrane, topical antibiotics, and antiviral drugs without any control of clinical signs and symptoms. Therefore, all anti-infective treatments were replaced with 0.66% povidone iodine (3 times/day) given alone for 5 weeks and then associated with serum eyedrops. When a clear regression of the ulcer was observed, the patient was maintained with serum eyedrops only. CONCLUSIONS Unusual treatment with povidone iodine 0.66% (used for the first time in an autoimmune patient), alone and in association with serum eyedrops, probably contributed to alleviate the signs and symptoms of a case of peripheral ulcerative keratitis not responding to conventional treatments. Although its regular use warrants further investigation, povidone iodine seems a useful therapeutic tool for the treatment of corneal ulcers associated with chronic immune-mediated inflammatory diseases.
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TL;DR: A multicenter, non-randomized, prospective, controlled study was conducted to evaluate the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery.
Abstract: A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery; the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM®) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure.
5 citations
TL;DR: 0.66% povidone iodine added to the antimicrobial treatment of a corneal abscess caused by Pseudomonas aeruginosa was effective, safe, and well tolerated in treating ocular infection caused by P. aerug in a contact lens wearer.
Abstract: Contact lens use is often associated with corneal infections. Pseudomonas aeruginosa is the most common cause of contact lens-associated infections. Its treatment is often challenging due to the ability of this opportunistic bacteria to be resistant to antibiotics that are, usually, prescribed empirically. Antiseptic could be an adjunctive therapy aiming to broaden the antimicrobial spectrum. Low concentration povidone iodine has rapid broad-spectrum activity against bacteria including P. aeruginosa, fungi, viruses, protozoa, and biofilms, lack of resistance and efficacy in wound healing process, along with an optimum safety and tolerability profile. The purpose of this case report was to show the effect of 0.66% povidone iodine added to the antimicrobial treatment of a corneal abscess caused by P. aeruginosa in a contact lens wearer. A 25-year-old female, with suspected microbial keratoconjunctivitis was empirically treated with topical antibiotics (gentamicin and moxifloxacin). After a worsening of the corneal abscess, subconjunctival injection of gentamicin was started and, with the aim of broadening the antimicrobial spectrum, 0.66% PVP-I (2 times a day) was added. Based on the antibiogram, registering abundant growth of P. aeruginosa, topical antibiotics were substituted with ciprofloxacin, while PVP-I was maintained until complete recovery. Combined treatment of antibiotics and PVP-I 0.66% was effective, safe, and well tolerated in treating ocular infection caused by P. aeruginosa. PVP-I could be a useful additional therapeutic tool for fighting P. aeruginosa infections, generally resistant to antibiotics, and to prevent clinical worsening pending the correct microbiological diagnosis.
2 citations
TL;DR:
Abstract: The aim of this prospective explorative study was to evaluate the safety and the effectiveness of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for pathogen identification and susceptibility testing in patients with infectious keratitis (IK). A corneal swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL). Twenty-five eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1, ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027 and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures (n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial therapy. The administration of 0.66% PVP-I during the time-to-result period seems to be a safe strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it showed to be effective in eyes with a Gram-positive bacterial infection.
1 citations
TL;DR: Rh-EGF combined with PVI has a definite curative effect on patients with PUs and can promote PU alleviation and hydroxyproline secretion in the wound and inhibit pain and inflammatory reactions, which is worthy of clinical promotion.
Abstract: Purpose To determine the clinical efficacy of recombinant human epidermal growth factor (rh-EGF) combined with povidone-iodine (PVI) on patients with pressure ulcers (PUs). Methods One hundred and five PU patients treated between January 2018 and January 2021 were enrolled and retrospectively analyzed. Of them, 50 patients who received conventional treatment were assigned to the control group (Con group), while 55 patients treated with rh-EGF combined with PVI were assigned to the observation group (Obs group). The two groups were compared in clinical efficacy, PU alleviation (total area reduction rate, total depth reduction rate, and total volume reduction rate), healing time, pain degree (Visual Analog Scale [VAS] score), inflammatory indexes (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitive C reactive protein [hs-CRP]), and hydroxyproline content in the wound. Results The Obs group yielded a higher total effective rate than the Con group (P < 0.05). The Obs group also experienced statistically shorter healing time and milder pain, with better PU alleviation and lower levels of inflammation indexes compared with the Con group (all P < 0.05). In addition, a higher hydroxyproline content in the wound was found in the Obs group. Conclusions All in all, rh-EGF combined with PVI has a definite curative effect on patients with PUs. It can promote PU alleviation and hydroxyproline secretion in the wound and inhibit pain and inflammatory reactions, which is worthy of clinical promotion.
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TL;DR: There is evidence that TNF-α inhibitors increase the serious infection risk up to 2-fold in a dose-dependent manner and glucocorticoids have been used as potent immunosuppressive drugs in RA, which has the potential to outweigh their risk when higher GC doses can be tapered down.
Abstract: RA is known to be associated with an increased risk of serious infection. Even more than 50 years ago, observational studies showed a greater than 2-fold increased risk of serious infection in RA. This was reinforced by various subsequent cohort studies. The elevated susceptibility of patients with RA can be explained by the pathobiology of the disease itself, the impact of chronic comorbid conditions, as well as sequelae of immunosuppressive treatment. It has been suggested that premature ageing of the immune system in RA contributes to weakened protection against infectious organisms. In addition, chronic comorbid conditions such as diabetes or chronic lung or kidney disease, disease-related functional disability, as well as lifestyle factors such as smoking, increase the risk in individual patients. For a long time glucocorticoids (GCs) have been used as potent immunosuppressive drugs in RA. There is evidence that they increase the risk of serious infections up to 4-fold in a dose-dependent manner. TNF-α inhibitors increase the serious infection risk up to 2-fold. They have, however, the potential to outweigh their risk when higher GC doses can be tapered down. If patients need higher dosages of GCs in addition to treatment with biologic agents, their risk of infection is substantial. This combination should be used carefully and, if possible, avoided in patients with additional risk factors such as older age or comorbid conditions.
411 citations
TL;DR: In this paper, the authors tested three commercial preparations of 10% povidone-iodine solution and found that the stock and dilute preparations of these products demonstrated rapid bactericidal action against Klebsiella pneumoniae, Pseudomonas cepacia, and Streptococcus mitis.
Abstract: Recent confirmation of intrinsic bacterial contamination of 10% povidone-iodine solution has raised questions regarding the bactericidal mechanism of iodophors and the possibility for survival of vegetative bacterial cells in iodophor solutions. In this laboratory investigation, five different species were exposed to various dilutions of three commercial preparations of 10% povidone-iodine solution; survival was assessed after exposure for time periods varying between 0 and 8 min. All brands of povidone-iodine solution tested demonstrated more rapid killing of Staphylococcus aureus and Mycobacterium chelonei at dilutions of 1:2, 1:4, 1:10, 1:50, and 1:100 than did the stock solutions, S. aureus survived a 2-min exposure to full-strength povidone-iodine solution but did not survive a 15-s exposure to a 1:100 dilution of the iodophor. Both stock and dilute preparations of 10% povidone-iodine solution demonstrated rapid bactericidal action against Klebsiella pneumoniae, Pseudomonas cepacia, and Streptococcus mitis.
325 citations
TL;DR: In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs, and assessments of infection risk related to newer and emerging therapies should carefully consider concomitant medication exposures.
Abstract: Objectives To assess the risk of severe infections associated with the use of traditional disease-modifying anti-rheumatic drugs (DMARDs) and glucocorticoid agents in rheumatoid arthritis (RA). Methods Our study was a case-control design nested within a cohort of 23 733 RA patients studied between 1 January 1980 and 31 December 2003. Matching on age and gender, and adjusting for comorbidity and physician use, conditional logistic regression was used to estimate the effect of specific drugs on the rate ratio (RR) for infections requiring hospitalization. Results The risk for all infections requiring hospitalization appeared to be most elevated with current exposures to cyclophosphamide [RR: 3.26, 95% confidence interval (CI): 2.28-4.67] and systemic glucocorticoid agents (RR: 2.56, 95% CI: 2.29-2.85); azathioprine was associated with a moderate increased risk (RR: 1.52, 95% CI: 1.18-1.97). There was a suggestion of increased risk of pneumonia due to methotrexate (RR: 1.16, 95% CI: 1.02-1.33). The results were similar for the period before and after the introduction of anti-tumour necrosis factor (TNF) agents. The RR point estimate for anti-TNF agents suggested about a 2-fold increased risk for all infections, but the estimate was imprecise. Conclusions In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs. Assessments of infection risk related to newer and emerging therapies should carefully consider concomitant medication exposures, including traditional DMARDs and glucocorticoid therapy.
272 citations
TL;DR: Povidone iodine has many characteristics that position it extraordinarily well for wound healing, including its broad antimicrobial spectrum, lack of resistance, efficacy against biofilms, good tolerability and its effect on excessive inflammation.
271 citations
TL;DR: The data support the hypothesis that dry eye is a localized autoimmune disease originating from an imbalance in the protective immunoregulatory and proinflammatory pathways of the ocular surface.
Abstract: Dry eye is a common ocular surface inflammatory disease that significantly affects quality of life. Dysfunction of the lacrimal function unit (LFU) alters tear composition and breaks ocular surface homeostasis, facilitating chronic inflammation and tissue damage. Accordingly, the most effective treatments to date are geared towards reducing inflammation and restoring normal tear film. The pathogenic role of CD4+ T cells is well known, and the field is rapidly realizing the complexity of other innate and adaptive immune factors involved in the development and progression of disease. The data support the hypothesis that dry eye is a localized autoimmune disease originating from an imbalance in the protective immunoregulatory and proinflammatory pathways of the ocular surface.
266 citations