Efficacy of topical cadexomer iodine treatment in chronic wounds: Systematic review and meta‐analysis of comparative clinical trials

Abstract

The aim of this study was to summarise the clinical evidence supporting almost 40 years of topical cadexomer iodine (CIOD) use in wound bed preparation by removing barriers to healing such as exudate, slough, bioburden, and infection and allowing chronic wound progression. A systematic review was conducted (Embase/PubMed, November 2020) to identify relevant comparative studies meeting inclusion criteria. Meta‐analyses were performed using a fixed‐effects (I2 < 50%) or random‐effects model (I2 ≥ 50%) depending on statistical heterogeneity. Dichotomous outcomes were reported as relative risk (RR) and continuous outcomes as mean difference (MD), with 95% confidence intervals. In total, 436 publications were identified of which 13 were comparative trials including outcomes of interest. Significant reductions in exudate, pus/debris, slough, bioburden, and infection were reported in chronic wounds treated with CIOD, compared with standard of care (SOC). Meta‐analyses highlighted the positive impact of CIOD on mean wound area reduction (MD = 2.35 cm2, 95% CI = 0.34–4.36, P = .0219) after eight weeks treatment and overall wound healing events compared to SOC; wounds including venous leg ulcers, diabetic foot ulcers, and pressure ulcers treated with CIOD were more than twice as likely to heal than those receiving SOC (RR = 2.30, 95% CI = 1.54–3.45, P < .0001). This meta‐analysis demonstrates the efficacy of CIOD on chronic wounds through removal of barriers to healing. CIOD should be considered in wound bed preparation and treatment protocols.

Povidone Iodine Ointment vs Cadexomer Iodine Ointment in Management of the Chronic Wound: A Study Protocol

“…A meta-analysis also have shown that Cadexomer Iodine Ointment is effective for chronic wound management since it removes the barriers which are hurdles in healing process. Thus, it can be used for preparation of wound bed for further line of treatment and management [22]. Various other studies have also been reviewed in view of management of different types of chronic wounds [23,24,25,26].…”

An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings

“…Actually, cadexomer beads play an important role in removing wound debris. [240] With the physical swelling of the cadexomer beads upon contact with the liquid, sustained availability of iodine is provided, and then the bacteria and biofilm are eliminated after 72 h with the least cytotoxicity effect. [241][242][243][244]…”

“…Due to its physical and antimicrobial properties, CIOD removes many of the barriers to healing (such as excessive exudate, slough, and bioburden) that are found especially in chronic wounds. [ 239,240 ] Cadexomer beads have been reported to absorb fluid up to seven times their own weight, which plays an important role in the effective management of exudates. Actually, cadexomer beads play an important role in removing wound debris.…”

Topical Management of Wound: A Narrative Review of Cadexomer Iodine Ointment Versus Povidone Iodine Ointment

“…Biofilms have recently been identified as a source of chronic wound infections and a delay in wound healing, with biofilms found in over 78% of chronic non-healing wounds like venous leg ulcers, diabetic foot ulcers, and pressure ulcers [ 27 ]. Biofilm provides a substantial clinical challenge, especially because of its increased antimicrobial tolerance and capacity to elude the human immune response.…”

“…The findings of various in vivo investigations show unequivocally that there is sufficient evidence to recommend the use of CI in chronic wounds. According to a review, there is insufficient evidence to demonstrate that CI has a deleterious effect on wound healing and infection [ 21 - 27 ].…”