Wound management, especially chronic wounds, has always been a challenging task for physicians and surgeons. There is ample evidence that chronic non-healing wounds are resistant to standard antimicrobial therapies due to the diversity of biofilms and the various drug-resistant flora associated with them. (1, 2)

In the past decade, there has been a surge in the trials of topical antibacterial drugs. These drugs can counteract and counteract the microbial flora in such chronic wounds and provide good beds for tissue repair. More and more evidence now emphasizes that Cadexomer Iodine (CI), a topical antibacterial agent based on iodophor, is one of the most effective drugs for the treatment of chronic wounds (3,4).

Cadexomer Iodine was developed in Sweden in the early 1980s and was initially shown to be effective in treating venous ulcers (5). With further research, the chronic wound healing efficacy of CI has received attention. Its new role in increasing wound epithelial regeneration has been fully confirmed (6)

Cadexomer Iodine microbeads are mainly provided in powder form, which exhibits its effects based on a dual strategy. When in contact with the wound site, the hydrophilic starch coating absorbs wound exudate, pus, liquid, etc. The beads swell and eventually release iodine, which is the main antibacterial agent. This dual role helps Cadexomer Iodine to effectively manage non-healing wounds (7), while strengthening its position in the medical world. In the past ten years, numerous studies supporting Cadexomer Iodine have been accumulated, so there is a lack of systematic evaluation and analysis.

To bridge this gap and review existing scientific data supporting the use of CI in various chronic wounds (including venous leg ulcers, diabetic feet, and pressure ulcers), Kevin Woo et al. recently conducted a Detailed meta-analysis. From Queen's University of Canada (8).

The review has been published in "International Wound Journal".

For the study design, a systematic search was conducted using literature related to cadexomer iodine and its brand name, iodine beads, or iodine-initiated AND ("wound healing" or "chronic wound"), and Embase and PubMed will be reviewed in November 2020 Relevant research will be determined on the 24th.

480 studies (including prospective and retrospective designs) evaluated the use of Cadexomer Iodine and related wound healing outcomes in patients of any age or with any risk factors for complications.

The outcome indicators of the assessment include infection, pain and wound area, and wound healing.

The data analysis highlights some interesting results, which are summarized below.

● Pain reduction—in six studies, compared with SOC, the visual analog scale (VAS) score was used to measure pain after CI intervention; the four VLUs included significant pain relief after 6, 9, and 8 weeks of treatment (10) , And a PU study (11), which proved that pain was significantly reduced during the 8-week study period (P <.02), which is famous. In another study, Holloway et al. Compared with SOC in VLU, CI showed a tendency to reduce pain.

● Reduction of wound area-Some RCTs have emphasized the significant improvement in wound area reduction of chronic wounds (VLU, DFU, and PU) after CI intervention.

Hansson et al. (12) showed that in the 12-week study, the area of ​​ulcers was reduced by 66%, while the SOC group was only 18% (P = .0127), and the healing rate was significantly higher than that of SOC (P = .0353). Hillstrom et al. (13) demonstrated that the VLU wound area after using Cadexomer Iodine was significantly reduced after only 1 week of treatment, and it continued until the end of the study (week 6). Strong and colleagues (14) also showed a significant reduction in ulcer size compared with SOC at 1, 2, 4, and 6 weeks (P <.01, P <.005, P <.01, P <. 02). In addition, Skog et al. emphasized a significant reduction in ulcer size at 1 and 2 weeks. (P<.02 and P<0.005, respectively) is equivalent to a 34% reduction in ulcer size after 6 weeks, while the ulcer size in the SOC group increases by 5%. (5) In the crossover test of Lindsay et al. (15), it was also noticed that the VLU area decreased after 8 weeks of Cadexomer Iodine treatment. (The SOC is 33.6% and 4.2%). Laudanska and Gustavson (9) pointed out that in the 6-week CI intervention, the average ulcer area was reduced by 71%, while the SOC group was reduced by 54% (P <.05). In DFU, it was reported that compared with baseline, the median wound area was reduced by 53.6% and the wound depth was reduced by 50% after Cadexomer Iodine treatment. (11)

● Wound healing—Several studies involving VLU, DFU and PU participants reported that the wound healed completely after the intervention of Cadexomer Iodine.

In studies spanning 6 weeks, 8 weeks, and 12 weeks of intervention, in VLU, compared with SOC, CI healed significantly more wounds (16). Similarly, in PU, the CI group reported significantly more healing events compared to the SOC in the RCT of Moberg et al. (11). In addition, in the open controlled comparative study of DFU, the CI group healed more wounds than the SOC control group. (8)

The results highlight some interesting facts, as follows −

1. Cadexomer Iodine is the only drug that reduces the total microbial load including biofilms in human clinical studies (17).

2. Compared with SOC (across VLU, DFU, and PU), wounds treated with Cadexomer Iodine are at least twice as likely to heal, resulting in significant savings in hospital care costs.

3. Recognizing the extensive influence of Cadexomer Iodine in the treatment of venous ulcers, it has been included in the treatment guidelines for the treatment of VLU (18).

Conclusion-Confirming that currently available wound healing data indicate that chronic wounds are more likely to be healed by CI treatment than SOC, the research team concluded that “a systematic review of clinical studies emphasizes how CI treatment can manage and reduce many of these obstacles, Helps wound healing progress. Existing evidence for the use of CI in clinical practice spans nearly 40 years, showing consistent successful results compared to SOC. Our understanding of the efficacy of iodine, especially CI, against new challenges such as biofilms Interest in this intervention has been rekindled. In addition, further real-world investigations of Cadexomer Iodine as part of the wound bed preparation and infection management protocol will show the impact of these benefits on patients and resources, translating observations from clinical research into clinical practice ."

The above article has been published by Medical Dialogue under the MD Brand Connect Initiative. For more details about Cadexomer Iodine, click here

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2. Kadam, S., Shai, S., Shahane, A. and Kaushik, KS (2019). The latest developments in non-traditional antibacterial methods for chronic wound biofilms: Have we found the "gap in the armor"? . Biomedicine, 7(2), 35. https://doi.org/10.3390/biomedicines7020035

3. Fitzgerald DJ, Renick PJ, Forrest EC, Tetens SP, Earnest DN, McMillan J, Kiedaisch BM, Shi L, Roche ED. Cadexomer iodine has excellent effects on bacterial wound biofilms in vitro and in vivo. Wound repair and regeneration. 2017 January; 25(1): 13-24. doi: 10.1111/wrr.12497. Epub 2016 December 5th. PMID: 27859922.

4. Roche, ED, Woodmansey, EJ, Yang, Q., Gibson, DJ, Zhang, H., & Schultz, GS (2019). Cadexomer iodine effectively reduces bacterial biofilm in pig wounds in vitro and in vivo. International Wound Journal, 16(3), 674-683. https://doi.org/10.1111/iwj.13080

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7. Wound Biofilm Management-Wounds International; https://www.woundsinternational.com ›Resources

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Dr. Kamal Kant Kohli, DTCD is a chest specialist with more than 30 years of practical experience and talent for writing clinical articles. Dr. Kamal Kant Kohli joined the Medical Dialogue as the editor-in-chief of the professional medical dialogue section. In addition to writing articles, as an editor, he proofreads and verifies all medical content published in medical conversations, including content from journals, research, medical conferences, guidelines, etc. Before joining Medical Dialogue, he held important positions in the medical industry in India including as Hony. Secretary of the Delhi Medical Association and Chairman of the Delhi Anti-Fraud Committee, and cooperates with other medical committees in India. Email: editorial@medicaldialogues.in. Contact information. 011-43720751