Comprehensive Assessment of the Efficacy of Chitosan-Based Wound Dressings in Combination With Various Antiseptics

Background: A pressing issue in modern purulent surgery is the growing number of microbial strains resistant to antibiotics. One of the strategies to address this issue is to develop novel wound dressings (WD) with incorporation of antiseptics that can prevent or reduce infection without conventional antibiotics.

Objective: To compare the efficacy of chitosan-based WD with immobilized antiseptics and their combinations in in vitro and in vivo experiments.

Materials and methods: We conducted a multistage randomized controlled in vitro and in vivo study investigating samples of chitosan-based WD with incorporated antiseptics (polyhexanide, octenidine dihydrochloride, povidone-iodine, and a combination of polyhexanide and octenidine) in international concentrations and diluted. The antimicrobial activity of antiseptics was evaluated in vitro by broth microdilution and disk diffusion methods. Staphylococcus aureus and Escherichia coli were used as reference cultures. For in vivo experiments, we formed experimental purulent wounds of soft tissues in laboratory animals (male rats weighing 300±50 g) according to our own method and treated the wounds with the investigated WD. The dynamics of the wound process was assessed by clinical and cytological data, as well as intravital ultrasonography findings.

Results: Depending on the prolongation of time to maintain an effective concentration in the wound and minimal irritating effect on the tissue, we ranked antiseptic agents as follows: polyhexanide>octenidine>povidone-iodine. The combination of polyhexanide and octenidine did not demonstrate the expected synergistic effect; however, it had a positive therapeutic effect on the wound comparable to that of other antiseptics used alone. The comprehensive assessment of the wound process showed that WD with immobilized polyhexanide demonstrated the best wound healing and antiseptic effect. Reliable signs of wound healing with further positive dynamics were observed by day 7. It was almost 2 times faster compared with other experimental samples.

Conclusions: Chitosan is a promising material to be used as a chemically inert matrix for programmed delivery of various drugs, including antimicrobial drugs, into the wound. The studied WD with immobilized antiseptics did not demonstrate a pronounced cytotoxic and depressing effect on processes of soft tissue remodeling and, on the contrary, significantly reduced the time of wound transition to the proliferation phase.

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