BNF for Children 2011-2012

596 13.11.4 Iodine BNFC 2011–201213.11.4 Iodine13.11.6 Oxidisers and dyes13 SkinPOVIDONE–IODINECautions broken skin (see below)Large open wounds The application of povidone–iodine tolarge wounds or severe burns may produce systemic adverseeffects such as metabolic acidosis, hypernatraemia, andimpairment of renal functionContra-indications preterm neonate gestational ageunder 32 weeks; infants body-weight under 1.5 kg;regular use in neonates; thyroid disorders; concomitantlithium treatmentRenal impairment avoid regular application toinflamed or broken skin or mucosaPregnancy sufficient iodine may be absorbed to affectthe fetal thyroid in the second and third trimesterBreast-feeding avoid regular or excessive useSide-effects rarely sensitivity; may interfere withthyroid function testsIndication and doseSkin disinfection see preparationsBetadine c (Mölnlycke)Dry powder spray, povidone–iodine 2.5% in a pressurisedaerosol unit, net price 150-g unit = £2.63For skin disinfection, particularly minor wounds and infections;child under 2 years not recommendedNote Not for use in serous cavitiesSavlon c Dry (Novartis Consumer Health)Powder spray, povidone–iodine 1.14% in a pressurisedaerosol unit, net price 50-mL unit = £2.39For minor woundsVidene c (Ecolab)Alcoholic tincture, povidone–iodine 10%, net price500 mL = £3.46DoseApply undiluted in pre-operative skin disinfectionNote Flammable—caution in procedures involving hot wirecautery and diathermy; avoid use in neonatesAntiseptic solution, povidone–iodine 10% inaqueous solution, net price 500 mL = £3.46DoseApply undiluted in pre-operative skin disinfection andgeneral antisepsisSurgical scrub, povidone–iodine 7.5% in aqueoussolution, net price 500 mL = £3.46DoseUse as a pre-operative scrub for hand and skin disinfection13.11.5 PhenolicsTriclosan has been used for disinfection of the handsand wounds, and for disinfection of the skin beforesurgery.HYDROGEN PEROXIDECautions large or deep wounds; avoid on healthy skinand eyes; bleaches fabric; incompatible with productscontaining iodine or potassium permanganateLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseSuperficial bacterial skin infection see underpreparation belowCrystacide c (GP Pharma)Cream, hydrogen peroxide 1%, net price 25 g = £8.07,40 g = £11.62DoseSuperficial bacterial skin infectionApply 2–3 times daily for up to 3 weeksExcipients include edetic acid (EDTA), propylene glycolPOTASSIUM PERMANGANATECautions irritant to mucous membranesIndication and doseCleansing and deodorising suppurating eczematousreactions (section 13.5.1) and woundsFor wet dressings or baths, use approx. 0.01% (1 in10 000) solutionNote Stains skin and clothingPotassium Permanganate SolutionSolution, potassium permanganate 0.1% (1 in 1000)in waterNote to be diluted 1 in 10 to provide a 0.01% (1 in 10 000)solutionPermitabs c (Alliance)Solution tablets, for preparation of topical solution,potassium permanganate 400 mg, net price 30-tabpack = £9.85Note 1 tablet dissolved in 4 litres of water provides a 0.01%(1 in 10 000) solution13.11.7 Preparations forpromotion of woundhealingDesloughing agents Alginate, hydrogel, and hydrocolloiddressings (see BNF appendix on wound management)are effective in wound debridement. Sterile larvae(maggots) (LarvE c , Zoobiotic) are also used formanaging sloughing wounds and are prescribable onthe NHS.Desloughing solutions and creams are of little clinicalvalue. Substances applied to an open area are easilyabsorbed and perilesional skin is easily sensitised.Growth factor A topical preparation of becaplermin(recombinant human platelet-derived growth factor) isused as an adjunct treatment of full-thickness, neuropathic,diabetic ulcers. It enhances the formulation ofgranulation tissue, thereby promoting wound healing.