A Review of the Clinical Evidence around the Use of Cadexomer Iodine as a Topical Antimicrobial Agent

Wound Bed Preparation (WBP) can be described as the management of the wound to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures. The 4 basic aspects of WBP can now be represented by an acronym, TIME T= tissue (non-viable or deficient), addressed clinically via debridement.  I= infection or inflammation, addressed clinically via antimicrobial agents.  M= moisture control, addressed clinically via absorbent dressings and/or compression.  E= epidermal margin, addressed clinically via tissue engineered constructs/grafts. Focusing on the “I” in TIME, there are numerous antimicrobial dressings that are intended to fulfill this need.  One category of dressings is based upon the antimicrobial properties of iodine.  Unlike some of the antimicrobial dressings currently used clinically, there exists a vast body of high quality clinical publications evaluating iodine based dressings.  The purpose of this review is to gain insight into the clinical efficacy and potential negative effects of one such dressing which controls the delivery of iodine to the wound via a cadexomer iodine delivery system.  Various aspects of this technology such as mode of action, release rates, clinical efficacy, cytotoxicity, etc. are reviewed. From this review it was found that unlike many wound care technologies, there exists an ample body of high quality clinical evidence in support of cadexomer iodine. With over 51 studies involving VLUs, PUs, DUs and thousands of patients, cadexomer iodine has been proven to promote wound closure in chronic wounds. It is clear that there are important differences amongst the various iodine based antimicrobial dressings, which leads to varying levels of efficacy, cytotoxicity, utility, etc. It is hoped that this review will provide clinically relevant (and clinically proven) insights into iodine based dressings, dispelling some of the myths around iodine dressings and confirming other aspects.