Role of Cadexomer Iodine in healing of Exuding Wounds
Management of acute and chronic wounds has undergone a drastic change depending on a multitude of factors. Exuding-non-healing chronic wounds type of wounds pose a much greater challenge for physicians due to a high risk of recurrent infections, thus prolonging the healing time (1). This, in turn, can go a long way to disrupt the quality of life of such patients, eventually affecting the physical as well as psychological well-being of the patients (2).
In such scenarios, one of the major factors that determine the prognosis of such wounds is the selection of an appropriate and effective dressing (3). Previous studies have extensively highlighted that among the various topical antimicrobials studied to date, iodine-based topical compounds are one of the most widely used and recommended by physicians for managing wounds. (4,5)
Over the last decade, there has been a spiked rise in novel and resistant strains of micro-organisms associated with exuding wounds. (6) To combat such rising cases, there has been a gross change in the protocols of wound management ollowed by modern clinicians.
Recent studies have suggested that cadexomer iodine is emerging as an effective iodine preparation in wound healing. (7,8)
Cadexomer iodine (CI) is a hydrophilic starch polymer bead, containing 0.9% w/w iodine. The polysaccharide beads swell in the presence of wound exudate, allowing a slow sustained release of iodine into the wound. The starch gel acts to extract microorganisms and debris from the wound, and the iodine creates an environment on the dressing, which prevents their culture
A recent study has shown that when in contact with wound exudates, cadexomer iodine releases free iodine (an antiseptic), which reduces the bacterial count (9). It also removes pus and debris, absorbs fluid, and facilitates desloughing. To promote the healing of chronic skin ulcers it also maintains a moist environment.
Despite the wide use of CI as a topical antimicrobial in wounds complicated by biofilm, there is
little evidence on their comparative efficacy when studied with other dressings in exudative wound patients. To bridge this gap, in 2019, a team of researchers under Sahitya Uppada et. al. sought to carry out a study to compare the effectiveness of Topical Cadexomer Iodine ointment and normal saline dressing in the management of acute and chronic exuding wounds. (10)
Findings from the study have been published in the Journal of Pharma Research.
MATERIALS AND METHODS
The study was designed as a prospective cohort study on topical cadexomer iodine ointment with 100 patients, who were included based on study criteria and were divided into two cohorts. Patients with Diabetic foot ulcers, I to IV stages of pressure ulcers, venous ulcers, Post cellulitis wounds, Abscess wounds and Post-trauma wounds were included. One cohort was given the treatment with topical cadexomer iodine ointment and another group was given with normal saline solution. All the 100 patients were observed during the study period of 6 months from October 2018 to March 2019. The study was performed at the general medicine department in Lalitha super-specialities hospital, Guntur, Andhra Pradesh.
Wound assessment was done using Bates-Jensen wound assessment tool, which includes rating sheet to assess wound status via parameters like wound size, depth, edges, undermining, necrotic tissue type, necrotic tissue amount, exudate type, exudate amount.
Both the dressings were placed following standard protocols and changed every 2 days. Data from baseline (week0) to week 10 was collected at intervals of 2 weeks, i.e; week 0, week 2, week 4, week 6, week 8 and week 10.
Data analysis revealed some interesting facts as follows:
• After 10 weeks of observation, topical cadexomer iodine demonstrated significant changes in all the parameters involved in wound healing like – wound size, depth, edges, undermining, necrotic tissue type and amount, exudate type and amount, skin colour surrounding the wound, peripheral tissue oedema and induration, granulation and epithelialization; reduction in pain and odour.
• The wound status continuum comparison was done with t-test procedure using SAS-9.2. The folded F value of 0.0490 infers that the test is statistically significant.
Observing the results, the research team has put forward an elaborate in-depth evaluation of the wound parameters.
1. Wound size- Cadexomer iodine group showed 1.5 times faster change in wound size when compared to the saline group. By the end of the study, 76% of cadexomer iodine subjects showed a reduction of wound size to less than 4 sqcm, while only 56% of patients from the saline group reported the same.
2. Wound depth- Change in depth is 2 times faster in case of the cadexomer iodine group when compared to the saline group.
3. Wound edges- Edges of the wound were indistinct in 76% of cadexomer iodine subjects, which is three-fold of 26% of saline group subjects. Further, by the end of the study, 98% of the cadexomer iodine group subjects showed no undermining, which was 76% in the case of the saline group.
4. Necrotic tissue type and amount- Significant reduction in necrotic tissue amount was seen by week 4 in case of cadexomer iodine group, while it was by week 10 in case of the saline group. By the end of the study, 90% of the cadexomer iodine subjects showed absence of necrotic tissue, while it was 62% in the case of the saline group.
5. Exudates type and amount- There was a significant reduction in exudate amount by week 4 in case of cadexomer iodine, which was gradual in case of saline dressing. By the end of the study, 70% of cadexomer iodine and 30% of saline group subjects showed no exudate. This suggested cadexomer iodine is two-fold times more effective in decreasing the exudate amount when compared to saline dressing.
The results of the study parameters clearly prove the superior efficacy of cadexomer iodine over saline dressing in healing wounds, specifically chronic exudating ones.
"In this study, wound healing with the use of topical cadexomer iodine was found to be dominant, when compared to saline dressing in several parameters involved in wound healing which were assessed using Bates-Jensen wound assessment tool. Most of the patients using topical cadexomer iodine are shown to be having improved wound status by week 4 significantly, while patients using saline have shown gradually improving wound with a slower rate of healing." wrote the team.
The above article has been published by Medical Dialogues under the MD Brand Connect Initiative. For more details on Cadexomer Iodine, click here
References
1. Frykberg, R. G., & Banks, J. (2015). Challenges in the Treatment of Chronic Wounds. Advances in wound care, 4(9), 560–582. https://doi.org/10.1089/wound.2015.0635
2. Nunan R, Harding KG, Martin P. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity. Dis Model Mech2014;7:1205–1213
3. Dabiri, G., Damstetter, E., & Phillips, T. (2016). Choosing a Wound Dressing Based on Common Wound Characteristics. Advances in wound care, 5(1), 32–41. https://doi.org/10.1089/wound.2014.0586
4. Williamson, D. A., Carter, G. P., & Howden, B. P. (2017). Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clinical microbiology reviews, 30(3), 827–860. https://doi.org/10.1128/CMR.00112-16
5. Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound Dressings and Comparative Effectiveness Data. Advances in wound care, 3(8), 511–529. https://doi.org/10.1089/wound.2012.0401
6. Bowler, P. G., Duerden, B. I., & Armstrong, D. G. (2001). Wound microbiology and associated approaches to wound management. Clinical microbiology reviews, 14(2), 244–269. https://doi.org/10.1128/CMR.14.2.244-269.2001
7. Roche, E. D., Woodmansey, E. J., Yang, Q., Gibson, D. J., Zhang, H., & Schultz, G. S. (2019). Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo. International wound journal, 16(3), 674–683. https://doi.org/10.1111/iwj.13080
8. Sundberg J, Pharm MS, Meller R, Se B, Pharm MS. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. Wounds A Compend Clin Res Pract. 1997;9(3):68‐86.
9. Sahitya Uppada, et al. TOPICAL CADEXOMER IODINE VERSUS SALINE DRESSING IN THE MANAGEMENT OF ACUTE AND CHRONIC EXUDING WOUNDS. J Pharm Res 2019;8(8):704-721. DOI: https://doi.org/10.5281/zenodo.3706446
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