A reappraisal of the use of antiseptics in surgical practice.
The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.
D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004351:Drug Resistance; D006168:Guinea Pigs; D006801:Humans; D051379:Mice; D009677:Noxythiolin / Q000627:therapeutic use; D010538:Peritonitis / Q000188:drug therapy; D011206:Povidone-Iodine / Q000627:therapeutic use; D051381:Rats; D013530:Surgical Wound Infection / Q000517:prevention & control; D000267:Tissue Adhesions
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D009677:Noxythiolin; D011206:Povidone-Iodine