ODOR MANAGEMENT IN FUNGATING WOUDS WITH METRONIDAZOLE versus PHMB: DOUBLE-BLINDED, RANDOMIZED, CLINICAL TRIAL

The odor has highlighted as one of the main signs of infected fungating wounds. Described as intolerable and nauseating being caused by interection of aerobic and anaerobic bacterias to colonize and infect the wounds. Aiming to reduce the microbial load location, has described the use of antiseptics and topical antibiotics, being more cited the metronidazole. In Brazil, metronidazole is available in the form of vaginal cream (8%-400mg/5g and 10%-500mg/5g), oral suspension (40mg/ml), oral tablets (250mg or 400mg) and parenteral solution (0.5%). As there are no ready formulations of metronidazole 0.8% topical solution, handling becomes necessary (metronidazole tablets associated with saline, for example – off lable). As in Brazil have topical solution polihexanide (PHMB) 0.2% to treat infected wounds, was conducted a double-blind, randomized clinical trial to verify if PHMB is effective in odor management. Twenty-four patients were recruited, being 12 in controlled group (metronidazole 0.8%) and 12 in experimental group (PHMB 0.2%). Was used the TELER® scale (patient's odour impact, odour rating, discomfort in dressing changing), odour quality (extremely offensive, moderate offensive, small offensive, non offensive) and Ferrans and Powers Quality of Life Index (QLI). The odour was measure in day 0, day 4 and day 8, or until odour was rating as "non odour" by 3 people. There was significative diference between 2 groups (p<0.001), showing that the PHMB is a therapeutic option to control the odor of fungating wouds.

* The study was conducted in a cancer hospital, after approval by the "Ethics Committee of University of São Paulo" and "Antonio Prudente Foundation" (CAAE : 04127512.9.0000.5392 ), and recorded in ClinicalTrial.gov (NCT02394821), and funded by the "Foundation Research of the State of São Paulo" (2013 / 01179-4).