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March 1983

Povidone-lodine Strikes Back

Arch Surg. 1983;118(3):367. doi:10.1001/archsurg.1983.01390030091015

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To the Editor.—In a recent report, Rodeheaver et al (ARCHIVES 1982; 117:181-186) reached the following conclusions: (1) Aqueous iodine solutions have a stronger and faster microbicidal action and contain more free iodine than povidone-iodine solution (P-I). (2) Iodophors do not decrease the rate of wound infection in contaminated experimental wounds. (3) "Iodine inhibits wound defenses." (4) "Exposure of contaminated wounds to iodine solutions results in a significantly higher infection rate." We will comment on these conclusions individually.

1. The slight antimicrobial in vitro superiority of aqueous iodine solution v P-I solution is irrelevant, since aqueous iodine has been out of clinical use in wound care since World War I due to its marked caustic action. Although P-I solution has less free iodine, it has excellent microbicidal activity even in low concentrations due to the narrow gap between its minimal inhibitory and minimal bactericidal concentrations for most bacteria of surgical

Lacey RW:  Antibacterial activity of povidone-iodine against nonsporing bacteria . J Appl Bacteriol 1979;46:443-449.Article
Custer J, Edlich RF, Prusak M, et al:  Studies in the management of the contaminated wound: V. An assessment of the effectiveness of pHisoHex and Betadine surgical scrub solutions . Am J Surg 1971;121:572-575.Article
Viljanto J:  Disinfection of surgical wounds without inhibition of normal wound healing . Arch Surg 1980;115:253-256.Article
Sindelar WF, Mason R:  Irrigation of subcutaneous tissue with povidone-iodine solution for prevention of surgical wound infections . Surg Gynecol Obstet 1979;148:227-231.