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Polyvinyl pyrrolidone- iodine as an intravenous antiseptic
Medical Hypotheses 17: 147-148, 1985
POLYVINYL PYRROLIDONE-
IODINE AS AN INTRAVENOUS ANTISEPTIC.
N. Werbin, Surgery "A", Ichilov Hospital, 6 Weizmann Street, 64239 Tel Aviv, Israel. Polyvinyl Pyrrolidone (PVP) was extensively used as a plasma expander (1) until newer, more effective products replaced it. It is still used in Europe and the USSR as such, but the more common use of this polymer is as binding agent for a multitude of drugs and cosmetics (2). One of the products thus developed (3) is the PVP-I, a universal antiseptic that found its place as one of the more commonly used cleansers and antiseptics. Although recommended for external use, experimental and clinical studies showed it to be safe enough for internal use as well (4,5,6). During these studies, a safe dose for i.p instilation was established (7) and few side effects were described. An article in the Russian literature caught our attention (8), in which antitoxic properties were related to the Russian made PVP. More recently, two other reports (9,lO) showed that PVP combined with metallic salts concentrated in or around malignant tumors and around abscesses and could be demonstrated radiologically. We know that P'JP concentrates most readily in reticula-endothelial system organs, is ingested by macrophages and most of its excretion is by the kidneys. When the molecular weight does not exceed 25000, virtually all the PVP injected is eliminated in the urine within the first three days and the remainder is excreted during the following days, the same way as low molecular dextran does (2). Combinig the above information, we injected intravenously several groups of mice with different concentrations of low molecular weight PVP-I, supplied by Napp laboratories U.K. We have found no remarkable abnormalities in the group of mice injected with low dose 0.5 ml 10% PVP-I per Kg weight, as compared with a control group, injected with saline in the same volume. Mice receivinq doses of more than 2.5 ml of 10% PVP-I per Kg weight died soon after injection (11). Following this information, we make the hypothesis that if PYP-I of low molecular weight can safely be injected intravenously, than such an injection or a drip infusion could act as a systemic antiseptic in cases of septicemia or could concentrate locally in deeply situated abscesses, PVP-I was found to be an excellent antiseptic agent with few adverse reactions. A new and wide field for investigation is opened if the parenteral use will in fact be found to be safe. 147
REFERENCES 1.
Ravin HA, Seligman AM. Fine J. Polyvinyl pyrrolidone as a expander. New England Journal of Medicine 247:921, 1952.
plasma
2.
Wessel W , Schoog M, Winkler E. Polyvinyl Pyrrolidone (PVP) its diagnostic, therapeutic and technical application and consequences thereof. Arzenheim Forsch (Drug Res) 21:1468, 1971.
3.
Shelanski HA, Shelanski MV. PVP iodine: history, toxicity and therapeutic uses. Journal of International College of Surgeons 25:727, 1956.
4.
Sindelar WP, Mason GR. Intraperitoneal irrigation with povidone iodine solution for the prevention of intraabdominal abscesses in the bacterially contaminated abdomen. Surgery Gynecology and Obstetrics 148:409, 1979.
5.
Werbin N, Orda R, Baratz M, Wiznitzer T. Preparation of the colon with povidone iodine enemas , an experimental study in dogs. Colo-Proctology 4:189, 1982.
6.
Merimsky E, Werbin N, Canetti R. Preoperative bladder irrigation with povidone iodide. British Journal of Urology 53:330, 1981.
7.
Lavinge JE, Brown CS, Machiedo GW, Blackwood JM, Rush BF. The treatment of experimental peritonitis with intraperitoneal beta dine solution. Journal of Surgical Research 16:307, 1974.
8.
Pushkar LN, Kosheraya VP, Troitskiy VB, et al. The use of blood substitutes with antitoxic properties in purulent surgical diseases. Khirurgia (Mosk) 48:82, 1972 (In Russian).
9.
Young SW, Enzmann B. Polyvinyl pyrrolidone contrast enhancement: abscess imaging. Radiology 133:511, 1979.
10. Young SW, Muller H, Merineck B. Contrast enhancement of malignant tumors after intravenous polyvinyl pyrrolidone with metallic salts as determined by computed tomography. Radiology 138:97,1981. 11. Werbin N, Guest M, Ostrzega N. Intravenous injection of povidone iodine. Submitted for Publication 1984.
148
POLYVINYL PYRROLIDONE-
IODINE AS AN INTRAVENOUS ANTISEPTIC.
N. Werbin, Surgery "A", Ichilov Hospital, 6 Weizmann Street, 64239 Tel Aviv, Israel. Polyvinyl Pyrrolidone (PVP) was extensively used as a plasma expander (1) until newer, more effective products replaced it. It is still used in Europe and the USSR as such, but the more common use of this polymer is as binding agent for a multitude of drugs and cosmetics (2). One of the products thus developed (3) is the PVP-I, a universal antiseptic that found its place as one of the more commonly used cleansers and antiseptics. Although recommended for external use, experimental and clinical studies showed it to be safe enough for internal use as well (4,5,6). During these studies, a safe dose for i.p instilation was established (7) and few side effects were described. An article in the Russian literature caught our attention (8), in which antitoxic properties were related to the Russian made PVP. More recently, two other reports (9,lO) showed that PVP combined with metallic salts concentrated in or around malignant tumors and around abscesses and could be demonstrated radiologically. We know that P'JP concentrates most readily in reticula-endothelial system organs, is ingested by macrophages and most of its excretion is by the kidneys. When the molecular weight does not exceed 25000, virtually all the PVP injected is eliminated in the urine within the first three days and the remainder is excreted during the following days, the same way as low molecular dextran does (2). Combinig the above information, we injected intravenously several groups of mice with different concentrations of low molecular weight PVP-I, supplied by Napp laboratories U.K. We have found no remarkable abnormalities in the group of mice injected with low dose 0.5 ml 10% PVP-I per Kg weight, as compared with a control group, injected with saline in the same volume. Mice receivinq doses of more than 2.5 ml of 10% PVP-I per Kg weight died soon after injection (11). Following this information, we make the hypothesis that if PYP-I of low molecular weight can safely be injected intravenously, than such an injection or a drip infusion could act as a systemic antiseptic in cases of septicemia or could concentrate locally in deeply situated abscesses, PVP-I was found to be an excellent antiseptic agent with few adverse reactions. A new and wide field for investigation is opened if the parenteral use will in fact be found to be safe. 147
REFERENCES 1.
Ravin HA, Seligman AM. Fine J. Polyvinyl pyrrolidone as a expander. New England Journal of Medicine 247:921, 1952.
plasma
2.
Wessel W , Schoog M, Winkler E. Polyvinyl Pyrrolidone (PVP) its diagnostic, therapeutic and technical application and consequences thereof. Arzenheim Forsch (Drug Res) 21:1468, 1971.
3.
Shelanski HA, Shelanski MV. PVP iodine: history, toxicity and therapeutic uses. Journal of International College of Surgeons 25:727, 1956.
4.
Sindelar WP, Mason GR. Intraperitoneal irrigation with povidone iodine solution for the prevention of intraabdominal abscesses in the bacterially contaminated abdomen. Surgery Gynecology and Obstetrics 148:409, 1979.
5.
Werbin N, Orda R, Baratz M, Wiznitzer T. Preparation of the colon with povidone iodine enemas , an experimental study in dogs. Colo-Proctology 4:189, 1982.
6.
Merimsky E, Werbin N, Canetti R. Preoperative bladder irrigation with povidone iodide. British Journal of Urology 53:330, 1981.
7.
Lavinge JE, Brown CS, Machiedo GW, Blackwood JM, Rush BF. The treatment of experimental peritonitis with intraperitoneal beta dine solution. Journal of Surgical Research 16:307, 1974.
8.
Pushkar LN, Kosheraya VP, Troitskiy VB, et al. The use of blood substitutes with antitoxic properties in purulent surgical diseases. Khirurgia (Mosk) 48:82, 1972 (In Russian).
9.
Young SW, Enzmann B. Polyvinyl pyrrolidone contrast enhancement: abscess imaging. Radiology 133:511, 1979.
10. Young SW, Muller H, Merineck B. Contrast enhancement of malignant tumors after intravenous polyvinyl pyrrolidone with metallic salts as determined by computed tomography. Radiology 138:97,1981. 11. Werbin N, Guest M, Ostrzega N. Intravenous injection of povidone iodine. Submitted for Publication 1984.
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