Professional Documents
Culture Documents
News,
February
2004
While povidone iodine has long been used by surgeons as a preoperative antiseptic,
researchers have been looking at the agent for treating viral conjunctivitis as well as other
ocular diseases.
The microbicidal action spectrum of povidone iodine (PI) is broad, even after short exposure
times. Further, unlike local antibiotics and other antiseptic substances, no resistance seems
to develop. The high degree of bactericidal efficiency with respect to highly resistant grampositive pathogenic micro-organisms, such as methicillin-resistant Staphylococcus
aureus (MRSA) andEnterococcus strains, has made the agent particularly useful and
significant for hospital hygiene.
Povidone iodine has traditionally been used by surgeons as a preoperative antiseptic.
Cheaper than topical antibiotics, it is recognized as a staple solution for preparing the eye
for surgery.
About 2 years ago, a stir was created when an ophthalmologist published anecdotal
evidence that a brief povidone iodine eye wash in patients known to be suffering from viral
conjunctivitis successfully helped to resolve the malady far faster than observation and
supportive therapy alone. Since that time, investigators have been evaluating the agent to
officially validate its use in this regard as well as potentially expand its role in the
management of ocular disease. (Shovlin JP, Abel R. Steroids, povidone iodine
recommended
for
adenoviral
keratoconjunctivitis. Primary
Care
Optometry
News. 2001;6(6):22-23.)
Mechanism of action
Double-masked trial
In a double-masked, controlled, prospective clinical trial involving 459 children (mean age
6.6 years with a range of 7 months to 21 years) diagnosed with acute bacterial, viral and
chlamydial conjunctivitis and from Manila, Philippines, infected eyes were cultured for
bacteria and underwent immunofluorescent testing for Chlamydia trachomatis. Viral
conjunctivitis was diagnosed if bacterial cultures were negative and if the diagnostic criteria
set forth in the study were met. Subjects were alternated to receive povidone iodine 1.25%
or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop four times daily in the
affected eye.
Povidone iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin Bgramicidin for treating bacterial conjunctivitis and was somewhat more effective
against Chlamydia, but was ineffective against viral conjunctivitis (Isenberg SJ, Apt L,
Valenton M, et al. A controlled trial of povidone-iodine to treat infectious conjunctivitis in
children.Am J Ophthalmol. 2002;134(5):681-688).
Practical evidence
In the Review of Optometry 2002 Clinical Guide to Ophthalmic Drugs, Melton and Thomas
present an off-label use of Betadine 5% solution to treat viral conjunctivitis (Melton R,
Thomas RK. 2002 Clinical Guide to Ophthalmic Drugs.Supplement to Review of
Optometry. 2002;139(6):40s).
After anesthetizing the eye with proparacaine solution, two drops of Betadine are instilled
onto the infected ocular surface for 1 minute. A sterile saline rinse is then used to
completely lavage the Betadine from the eye. Melton and Thomas report that the Betadine
rinse treatment followed by a course of topical steroid drops (two to four times daily),
artificial tears and cold compresses over a 1- to 3-week period can result in the expeditious
resolution of the signs and symptoms of viral conjunctivitis.
http://www.healio.com/optometry/therapeutics/news/print/primary-care-optometrynews/%7B30c8c986-33f4-4561-9d29-1314684fa7e7%7D/povidone-iodine-useful-formore-than-preoperative-antisepsis