Protocolo de tratamiento de heridas con apósito de hidrofibra reforzada, con plata iónica al 1,2%, potenciado con EDTA y cloruro de bencetonio para evitar la recurrencia de biopelícula.

OBJECTIVE: Present a treatment protocol to avoid biofilm reformation in hard-to-heal wounds, using a hydrofiber dressing with 1.2% ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride. METHOD: A retrospective, descriptive and analytic study on the use of a treatment protocol, including three case studies. Patient records for hard-to-heal wounds were analysed according to an algorithm for biofilm detection and best-practice recommendations for wound hygiene. RESULTS: The adopted protocol was based on three pillars: identifying clinical signs suggesting biofilm, performing wound hygiene, and applying an antibiofilm dressing. CONCLUSION: Wound healing rates can improve after protocol implementation. Adequate control of local signs of infection and exudate, as well as visual and indirect signs of biofilm, were achieved. All patients progressed well towards wound-size reduction and closure using the hydrofiber dressing.

OBJETIVO: Presentar un protocolo para evitar la reformación de biopelícula en heridas de difícil cicatrización con apósito de hidrofibra reforzada, con plata iónica al 1,2%, potenciado con ácido etilendiaminotetraacético (EDTA) y cloruro de bencetonio. MÉTODO: Estudio retrospectivo, descriptivo y analítico de aplicación de un protocolo de tratamiento, con tres casos de estudio de pacientes tratados en un centro de referencia internacional. Los registros de pacientes con úlceras complejas se analizaron y evaluaron de acuerdo con la inserción en el algoritmo de identificación clínica de biopelículas, y en base a las recomendaciones prácticas para la higiene de heridas. RESULTADOS: El protocolo adoptado se basó en tres pilares: identificación de signos clínicos de sugerencia para la presencia de biopelícula, prácticas de higiene en las heridas, y aplicación de la cobertura de antibiopelícula. CONCLUSIÓN: La capacidad de cicatrización de heridas con este protocolo puede considerarse alta. Los pacientes obtuvieron un adecuado control de todos los signos locales de infección y de exceso de exudado, y la desaparición de los signos visuales e indirectos de biopelícula. Todos presentaron una adecuada progresión, disminución de la superficie de la herida, y cicatrización tras el uso del apósito.

Protocolo de tratamiento de heridas con apósito de hidrofibra reforzada, con plata iónica al 1,2%, potenciado con EDTA y cloruro de bencetonio para evitar la recurrencia de biopelícula.

OBJECTIVE: Present a treatment protocol to avoid biofilm reformation in hard-to-heal wounds, using a hydrofiber dressing with 1.2% ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride. METHOD: A retrospective, descriptive and analytic study on the use of a treatment protocol, including three case studies. Patient records for hard-to-heal wounds were analysed according to an algorithm for biofilm detection and best-practice recommendations for wound hygiene. RESULTS: The adopted protocol was based on three pillars: identifying clinical signs suggesting biofilm, performing wound hygiene, and applying an antibiofilm dressing. CONCLUSION: Wound healing rates can improve after protocol implementation. Adequate control of local signs of infection and exudate, as well as visual and indirect signs of biofilm, were achieved. All patients progressed well towards wound-size reduction and closure using the hydrofiber dressing.

OBJETIVO: Presentar un protocolo para evitar la reformación de biopelícula en heridas de difícil cicatrización con apósito de hidrofibra reforzada, con plata iónica al 1,2%, potenciado con ácido etilendiaminotetraacético (EDTA) y cloruro de bencetonio. MÉTODO: Estudio retrospectivo, descriptivo y analítico de aplicación de un protocolo de tratamiento, con tres casos de estudio de pacientes tratados en un centro de referencia internacional. Los registros de pacientes con úlceras complejas se analizaron y evaluaron de acuerdo con la inserción en el algoritmo de identificación clínica de biopelículas, y en base a las recomendaciones prácticas para la higiene de heridas. RESULTADOS: El protocolo adoptado se basó en tres pilares: identificación de signos clínicos de sugerencia para la presencia de biopelícula, prácticas de higiene en las heridas, y aplicación de la cobertura de antibiopelícula. CONCLUSIÓN: La capacidad de cicatrización de heridas con este protocolo puede considerarse alta. Los pacientes obtuvieron un adecuado control de todos los signos locales de infección y de exceso de exudado, y la desaparición de los signos visuales e indirectos de biopelícula. Todos presentaron una adecuada progresión, disminución de la superficie de la herida, y cicatrización tras el uso del apósito.

New oral hygiene care regimen reduces postoperative oral bacteria count and number of days with elevated fever in ICU patients with esophageal cancer.

Using a controlled pre/post study design, we investigated the effects of professional mechanical cleaning of the oral cavity with benzethonium chloride, interdental brushes, and hydrogen peroxide on the number of oral bacteria and postoperative complications among esophageal cancer patients in an intensive care unit. Before surgery, 44 patients with esophageal cancer were recruited at Okayama Hospital from January through August 2015. The control group (n = 23) received routine oral hygiene care in the intensive care unit. The intervention group (n = 21) received intensive interdental cleaning with benzethonium chloride solution and tongue cleaning with hydrogen peroxide. The number of oral bacteria on the tongue surface and plaque index were significantly lower in the intervention group than in the control group on postoperative days 1 and 2 (P < 0.05). Additionally, the number of days with elevated fever during a 1-week period was significantly lower in the intervention group than in the control group (P = 0.037). As compared with routine oral hygiene, a new oral hygiene regimen comprising benzethonium chloride, interdental brushes, and hydrogen peroxide significantly reduced the number of oral bacteria and days with elevated fever in patients with esophageal cancer.

Coste-eficiencia de la elección de apósitos en heridas crónicas con biofilm basado en un modelo teórico / Cost efficiency of the choice of dressings in chronic wounds with biofilm based on a theoretical model

La elección del apósito correcto es una de las principales preocupaciones en la cura avanzada de heridas. Por un lado, se encuentra el continuo desarrollo de productos y, por otro, la reciente preocupación por el impacto en los costes de una indicación correcta. Uno de los factores que favorecen el de los costes es la evolución tórpida de las heridas, siendo la presencia de biofilm uno de los motivos de esta mala evolución. El cuidado de la herida con biofilm es uno de los mayores retos para los clínicos. Objetivo: Evaluar la costo-eficiencia de un apósito de hidrofibra con plata, EDTA y cloruro de benzetonio como apósito de primera elección en las heridas con presencia de biofilm. Metodología: Mediante un modelo teórico de heridas crónicas divididas en dos grupos y considerando que el 60% de las heridas de ambos grupos presentan biofilm, se han comparado los costes de utilizar un apósito de alginato con plata como primera elección en un primer grupo y un apósito de hidrofibra con plata, EDTA y cloruro de benzetonio como primera elección en el segundo grupo. Para el cálculo de costes se ha considerado la oferta de precios del concurso público de apósitos de la Plataforma Logística Provincial de Sevilla. Resultados: El coste medio herida/día para las heridas del primer grupo es de 0,59 Euros, mientras para el segundo grupo de 0,55 Euros. Conclusiones: El apósito de hidrofibra con plata, EDTA y cloruro de benzetonio es el apósito de elección y resulta costoefectivo frente al apósito comparado

Choosing the right dressing is one of the most important preoccupations in advanced wound healing. On the one hand, a constant development of wound dressings is found and, on the other, an increasing concern about the impact of a correct indication on costs. One of the factors increasing costs is wounds' torpid evolution, being the presence of biofilm one of the reasons of this bad evolution. Wound care managing biofilm is one of the biggest challenges for the clinicians. Objective: To evaluate the cost efficiency of a hydrofiber dressing with silver, EDTA and benzethonium chloride as first choice in dressing wounds with the presence of biofilm. Methodology: Using a theoretical model of chronic wounds divided into two groups and considering that 60% of the wounds of both groups have biofilm, have compared the costs of using an alginate dressing with silver as first choice in a first group and a hydrofiber dressing with silver, EDTA and benzethonium chloride as the first choice in the second group. To calculate costs, a public tender for dressings costs by the Provincial logistics platform in Seville has being considered. Results: The average cost wound / day for wounds of the first group is 0.59 Euros while for the second group is 0.55 Euros. Conclusions: Hydrofiber dressing with silver, EDTA and benzethonium chloride is the dressing of choice and cost-effective dressing against the other compared dressing

Novel Multivalent Wound-Healing Ointment Provides Bioburden Control and Moisture Management: A Retrospective Registry Data Analysis.

OBJECTIVE: The purpose of this retrospective registry data analysis was to explore the effectiveness of a novel multivalent topical ointment (Terrasil Infection Control Wound Care Ointment; Aspiera Medical, Woonsocket, Rhode Island), containing a patented mineral complex and 0.2% benzethonium chloride in the treatment of nonhealing acute and chronic wounds. DESIGN: Aspiera Medical designed a registry to capture physician experiences and treatment results with Terrasil Infection Control Wound Care Ointment. Physicians were asked to enter deidentified patient data into an online registry. SETTING: Wound clinics in the United States were asked to participate in the registry. PATIENTS: Physicians at 4 wound clinics treated 30 patients (26 of whom completed the treatment) with various chronic wounds that had persisted for an average of 6 months and entered treatment data into the registry. INTERVENTIONS: Patients applied the ointment according to physician orders. Concurrent treatments used by patients included offloading, compression wraps, and dressings, such as collagen and calcium alginate. Patients were treated until complete wound closure or lost to follow-up. MAIN OUTCOME MEASURES: Physicians calculated each patient's percentage wound reduction at each visit. MAIN RESULTS: Thirty patients were entered into the registry. Pretreatment and posttreatment measurements were available for 26 of them. Patients achieved an average surface area reduction of 84% in a mean of 23 days' treatment. CONCLUSION: The antimicrobial and moisturizing ointment studied appears to be effective in promoting wound closure in a variety of acute and chronic wounds. Wounds studied included diabetic foot ulcers, venous leg ulcers, venous stasis ulcers, surgical infections, burns, and insect bites. The results of this registry data analysis will be used to inform planned clinical trials.

Assessment of oral malodor and tonsillar microbiota after gargling with benzethonium chloride.

The oropharyngeal area can be a source of halitosis. However, the relationship between healthy tonsillar microbiota and halitosis is poorly understood. We conducted a pilot clinical study to clarify the effect of gargling with an antiseptic agent on tonsillar microbiota in patients with halitosis. Twenty-nine halitosis patients who did not have otolaryngologic disease or periodontitis were assigned randomly to one of three groups: benzethonium chloride (BZC) gargle; placebo gargle; no gargle. Concentrations of volatile sulfur compounds (VSCs) in mouth air, the organoleptic score (ORS) and tongue-coating score (TCS) were measured before and after testing. Tonsillar microbiota were assessed by detection of periodontal pathogens, and profiling with terminal-restriction fragment length polymorphism (T-RFLP) analysis and sequencing of 16SrRNA clone libraries for taxonomic assignment. Gargling with BZC reduced the concentrations of methyl mercaptan and hydrogen sulfide and the ORS, but did not affect the TCS or prevalence of periodontal pathogens. T-RFLP analyses and 16SrRNA clone sequencing showed a tendency for some candidate species to decrease in the test group. Although gargling of the oropharyngeal area with an antiseptic agent can reduce oral malodor, it appears that tonsillar microbiota are not influenced greatly. (J Oral Sci 58, 83-91, 2016).

The lack of effectiveness of hyperbaric oxygenation as a treatment for Leishmania major in a mouse model.

We aimed to study the effectiveness of hyperbaric oxygen therapy (HOT) (100% oxygen at 2 ATA for 70 minutes each session for 20 consecutive days) on BALB/c male mice infected with Leishmania major. Fifty-one mice were assigned to six groups. Group 1 was treated with HOT from 1 day after the inoculation. In Groups 2-5, treatment began when the cutaneous lesions appeared. Group 2 received HOT only, Group 3 received topical therapy with Leshcutan only, Groups 4 and 5 received a combination of HOT and Leshcutan for 5 and 10 days respectively, and Group 6 did not receive any treatment (control group). When comparing the control group with Group 1, treatment with HOT in Group 1 did not significantly affect the time of the appearance of the lesions. In contrast, mice treated with Leshcutan demonstrated a significant difference in lesion size and spleen dimensions as compared to the rest of the mice (p<0.001). The results show that HOT treatment has no positive effect on the course of Leishmaniasis in a BALB/c mice model infected with Leishmania major. Further studies are needed with a mouse model closer to humans and with different HOT protocols.

Co-delivery of chemosensitizing siRNA and an anticancer agent via multiple monocomplexation-induced hydrophobic association.

Synergistic combination of gene targeting and chemotherapy by co-delivering siRNA and anticancer drugs has widely been investigated to develop siRNA-based therapeutics for cancer treatment. Despite clinical potential of this approach, big challenges still remain such as delivery efficiency or stability/biocompatibility of the siRNA delivery system. Here we report a simple and biocompatible co-delivering formulation based on a unique complexation method, i.e., multiple monocomplexation-induced hydrophobic association between Bcl-2 targeting siRNA and a monocationic anticancer agent (benzethonium chloride, BZT). A colloidal formulation of the hydrophobically associated multiple monocomplex (HMplex) composed of siRNA, BZT and Pluronic F-68 was spontaneously constructed by physical mixing of the ternary constituents. In vitro and in vivo studies revealed that the ternary HMplex with a low charge ratio (N/P=4) possesses a tightly complexed stable nanostructure with Pluronic surface and small colloidal size less than 10nm, which allowed for 1) suitable protection of siRNA in serum-rich physiological environment, 2) efficient intracellular transfection into the cytoplasm, and 3) successful peritumoral co-delivery into the tumor tissue with dense interstitial matrix. Compared to non-targeting HMplexes between scrambled siRNA and BZT, Bcl-2 targeting HMplexes enhanced significantly both mRNA down-regulation by siRNA and apoptosis induction by BZT, and thus greatly suppressed the tumor volume when administered to highly aggressive and resistant human breast cancer xenografts (MDA-MB-231) in mice. These results elucidate that the co-complexed siRNA and BZT were liberated by intracellular decomplexation to trigger a synergistically combined therapeutic action. The successful siRNA/chemodrug co-delivery in vivo via peritumoral route and the greatly promoted therapeutic efficacy thereby represent the clinical potential of HMplexes for adjuvant locoregional cancer treatment by gene-targeted combination therapy.

An in vitro test of the efficacy of an anti-biofilm wound dressing.

Broad-spectrum antimicrobial agents, such as silver, are increasingly being formulated into medicated wound dressings in order to control colonization of wounds by opportunistic pathogens. Medicated wound dressings have been shown in-vitro to be effective against planktonic cultures, but in-vivo bacteria are likely to be present in biofilms, which makes their control and eradication more challenging. Recently, a functional wound dressing (AQUACEL(®) Ag+ Extra™ (AAg + E)) has been developed that in addition to silver contains two agents (ethylenediaminetetraacetic acid (EDTA) and benzethonium chloride (BC)) designed to disrupt biofilms. Here, the efficacy of AAg + E is demonstrated using a biofilm model developed in an isothermal microcalorimeter. The biofilm was seen to remain viable in the presence of unmedicated dressing, silver-containing dressing or silver nitrate solution. In the presence of AAg + E, however, the biofilm was eradicated. Control experiments showed that neither EDTA nor BC alone had a bactericidal effect, which means it is the synergistic action of EDTA and BC disrupting the biofilm with silver being bactericidal that leads to the product's efficacy.

Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials.

BACKGROUND: High cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting. METHODOLOGY/PRINCIPAL FINDINGS: We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26-1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54-0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56-1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV. CONCLUSIONS/SIGNIFICANCE: Topical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research.

Cutaneous leishmaniasis.

Cutaneous leishmaniasis is a widespread tropical infection caused by numerous different species of Leishmania protozoa that are transmitted by sandflies. Its clinical presentations are extremely diverse and dependent on a variety of parasite and host factors that are poorly understood. Diagnosis should aim to identify the exact species involved, but this requires laboratory investigations that are not widely available. No single ideal treatment has been identified, and those available are limited by variable success rates and toxicity. Clinical guidelines are needed to make better use of the investigations and treatments that do exist. Prevention is currently limited to bite prevention measures.

Leishmania major: in vitro and in vivo anti-leishmanial activity of paromomycin ointment (Leshcutan) combined with the immunomodulator Imiquimod.

Paromomycin at 25, 50 and 100 microg/ml, inhibited the growth of Leishmania major amastigotes by 34.5%, 61.2%, 74.9% and 85.4%, 89.9%, 95.7% on the 2nd and the 4th day of treatment in culture, respectively. Methylbenzethonium chloride at 0.1 and 0.5 microg/ml and Imiquimod at 5 and 10 microg/ml, administered separately, inhibited the parasite development by 39.5% and 65.2% and 31.5% and 47.7%, respectively. Imiquimod (5-10 microg/ml) combined with either paromomycin (25, 50 and 100 microg/ml) or methylbenzethonium chloride (0.1 and 0.5 microg/ml) showed an anti-leishmanial additive effect. A 10 day topical treatment, twice daily, with an ointment containing 15% paromomycin and 12% methylbenzethonium chloride (Leshcutan), either undiluted or diluted 1:5 in soft white paraffin combined with 5% Imiquimod cream (Aldara), was as effective as Leshcutan given alone. The present study suggests that a combination of Aldara and Leshcutan is as effective as Leshcutan given alone in the topical treatment of CL caused by L. major.

Otitis externa: Review and clinical update.

Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1,000 persons annually and the chronic form affecting 3 to 5 percent of the population. Acute disease commonly results from bacterial (90 percent of cases) or fungal (10 percent of cases) overgrowth in an ear canal subjected to excess moisture or to local trauma. Chronic disease often is part of a more generalized dermatologic or allergic problem. Symptoms of early acute and most chronic disease include pruritus and local discomfort. If left untreated, acute disease can be followed by canal edema, discharge, and pain, and eventually by extra-canal manifestations. Topical application of an acidifying solution is usually adequate in treating early disease. An antimicrobial-containing ototopical is the preferred treatment for later-stage acute disease, and oral antibiotic therapy is reserved for advanced disease or those who are immunocompromised. Preventive measures reduce recurrences and typically involve minimizing ear canal moisture, trauma, or exposure to materials that incite local irritation or contact dermatitis.

Benzethonium chloride: a novel anticancer agent identified by using a cell-based small-molecule screen.

PURPOSE: This study aims to identify a novel therapeutic agent for head and neck cancer and to evaluate its antitumor efficacy. EXPERIMENTAL DESIGN: A cell-based and phenotype-driven high-throughput screening of approximately 2,400 biologically active or clinically used compounds was done using a tetrazolium-based assay on FaDu (hypopharyngeal squamous cancer) and NIH 3T3 (untransformed mouse embryonic fibroblast) cells, with secondary screening done on C666-1 (nasopharyngeal cancer) and GM05757 (primary normal human fibroblast) lines. The "hit" compound was assayed for efficacy in combination with standard therapeutics on a panel of human cancer cell lines. Furthermore, its mode of action (using transmission electron microscopy and flow cytometry) and its in vivo efficacy (using xenograft models) were evaluated. RESULTS: Benzethonium chloride was identified as a novel cancer-specific compound. For benzethonium (48-hour incubation), the dose required to reduce cell viability by 50% was 3.8 micromol/L in FaDu, 42.2 micromol/L in NIH 3T3, 5.3 micromol/L in C666-1, and 17.0 micromol/L in GM05757. In vitro, this compound did not interfere with the effects of cisplatin, 5-fluorouracil, or gamma-irradiation. Benzethonium chloride induced apoptosis and activated caspases after 12 hours. Loss of mitochondrial membrane potential (DeltaPsiM) preceded cytosolic Ca2+ increase and cell death. In vivo, benzethonium chloride ablated the tumor-forming ability of FaDu cells, delayed the growth of xenograft tumors, and combined additively with local tumor radiation therapy. Evaluation of benzethonium chloride on the National Cancer Institute/NIH Developmental Therapeutics Program 60 human cancer cell lines revealed broad-range antitumor activity. CONCLUSIONS: This high-throughput screening identified a novel antimicrobial compound with significant broad-spectrum anticancer activity.

Hexadecyl-phosphorylcholine ointment for treatment of cutaneous leishmaniasis: an animal trial.

A placebo-controlled trial compared 6% hexadecyl-phosphorylcholine (HePC) and 12% benzethonium chloride ointment with placebo ointment for treatment of cutaneous leishmaniasis. Cutaneous lesions were experimentally induced by inoculation with leishmania promastigotes in 60 golden hamsters. Forty (40) animals were treated with drug and 20 with placebo ointment applied twice daily for 15 days. After treatment, all lesions were significantly reduced in size in the treatment group compared with the placebo ointment. No parasites were detected in smears from 35/40 of the drug-treated lesions and no relapses occurred over 120 days of observation.

Successful topical treatment of murine cutaneous leishmaniasis with a combination of paromomycin (Aminosidine) and gentamicin.

Cutaneous leishmaniasis is presently treated with 20 days of parenteral therapy with a frequently toxic drug (antimony). Topical formulations of paromomycin (15%) plus methylbenzethonium chloride (MBCL, 12%) or plus urea (10%) in soft white paraffin have been tested for Old and New World disease in humans. We compared the efficacy of a new topical formulation, WR 279,396 (paromomycin [15%] plus gentamicin [0.5%]) to the clinical formulations in the treatment of cutaneous disease in BALB/c mice. Sixty-day-old lesions were treated twice a day for 10 days, and the response to therapy was determined over a further 70 days. For ulcers due to Leishmania major or to Leishmania mexicana, 100% of lesions in the WR 279,396 group healed by day 20 after therapy and did not relapse by day 70; 83% of lesions healed without relapse in the paromomycin-MBCL group. In the paromomycin-urea group, 100% of L. major lesions healed by day 30 but 30% relapsed. For ulcers due to Leishmania panamensis or Leishmania amazonensis, all lesions treated with WR 279,396 healed and did not relapse; < 50% of lesions treated with paromomycin-MBCL healed by day 30, and all lesions relapsed by day 70. In addition to being active, WR 279,396 was not toxic in this model and appears to have a cosmetic effect (promoting hair growth, healing, and limiting the size of the scar).