Local
infection and
burn wound sepsis are one of the most severe problems in the treatment of thermally injured patients. Early surgical treatment and the use of topical
antiseptics led to a decrease in the
infection rate and significantly improved the survival rate of
burns patients within the last twenty-five years. Many
antiseptics are used in the treatment of
burns.
Silver nitrate,
silver sulphadiazine,
sulfamylon and
povidone-iodine (
PVP-I) are the most common substances used worldwide in
burn care facilities. Clinical studies demonstrate that treatment with
PVP-I is the most effective against bacterial and
fungal infection. Several methodological problems however arise from direct comparison between these
antiseptics, and local and systemic adverse effects can make the right choice difficult. Some case reports documented possible side effects in the treatment of patients with
PVP-I, leading to general concerns about this treatment. Absorption of
iodine and possible changes in
thyroid hormones are well known, but evaluation of the clinical consequences is controversial. Reports of severe
metabolic acidosis and
renal insufficiency with lethal results have condemned the use of
PVP-I in the treatment of extensive
burns. The case reports, however, dealt with patients suffering from general morbidity and
sepsis and therefore these single reports may not be generally valid. Local treatment of
burns may cause further problems. The beneficial effect of a decrease of bacterial counts in deeper tissue may be confounded by other effects delaying wound healing, as shown in some experimental studies. Controlled clinical investigations on
burn patients however are still missing. The paper will discuss these topics in detail referring to the treatment of
burns with
PVP-I. It is based on a critical review of the literature and the author's own experience in
burns therapy.