IODOSORB^◊

IODOSORB  an effective anti-biofilm dressing^1-3

IODOSORB is a unique antimicrobial dressing made of cadexomer smart micro-beads: spherical starch structures loaded with 0.9% elemental iodine.

Cadexomer smart micro-bead technology

IODOSORB is indicated for use in hard to heal chronic exuding wounds such as:

• venous leg ulcers,
• diabetic foot ulcers
• pressure ulcers   

IODOSORB removes the barriers to healing^{1, 4-7} and it is particularly effective against biofilm^1-3,5 thanks to its unique dual action that combines:

• Highly absorptive property^8-10
• Sustained antimicrobial release^{4, 11}

IODOSORB  has a very comprehensive evidence package, spanning more than 30 years of use, which includes:

• A positive Cochrane review¹²
• Independent data
• in vitro
• in vivo
• RCTs.

IODOSORB ointment	IODOFLEX◊	IODOSORB powder

References

1. Fitzgerald, D. J. et al. Wound Repair Regen. 1–40 (2016);
2. Schultz, G. & Yang. Poster presented at WUWHS Florence (2016);
3. Phillips P, Int Wound J. 1-15 (2013)
4. Skog E, et al. Br. J. Dermatol. 1983;109:77–83. 
5. Malone, M. et al. J. Wound Care 25,12, 20–25 (2016)
6. Ormiston MC and Fox J. Br. Med. J. (Clin. Res. Ed). 291, 1424–1425 (1985)
7. Hansson C, et al. Int. J. Dermatol. 37, 390–396 (1998)
8. Akiyama H, et al. J. Dermatol. 2004;31:529–34.
9. Troëng T, et al. E. A. in Cadexomer Iodine, (eds. Fox, J. & Fisher, H.) Schattauer Verlag. 1983:43–50.
10. Holloway, G. A., et al. West. J. Med. 1989; 151:35–38
11. Smith & Nephew Data on file #091101. 2009.
12. O’Meara, S. et al. Cochrane database Syst. Rev. 1, CD003557 (2014).

IODOSORB a unique dual action

	Dehydration of the biofilm matrix3 Desloughing action8, 9 Promotes autolytic debridement1 Effective exudate management1,9
	Killing the exposed biofilm bacteria3 Sustained gentle release of iodine4,5 Broad spectrum antimicrobial efficacy10-12

Watch an animation of IODOSORB's mode of action

IODOSORB a unique mode of action

Cadexomer bead absorbs exudate1,9,12	Iodine kills bacteria 3-6	IODOSORB changes colour
When IODOSORB is applied to the wound, fluids such as exudate are absorbed into the micro-bead causing it to swell.	As the bead swells its internal bonds break and active iodine is released producing sustained antimicrobial action for up to 72 hours 4-6 The release of iodine from the micro-bead is proportional to the volume of fluid absorbed: The more wound fluid absorbed the more active Iodine is released 6,13,14	The process stops once equilibrium is established between IODOSORB and the wound environment A noticeable colour change occurs indicating that it is time to change the dressing

References

1. Troëng T, et al. E. A. in Cadexomer Iodine, (eds. Fox, J. & Fisher, H.) Schattauer Verlag. 1983:43–50.
2. Holloway, G. A., et al. West. J. Med. 1989; 151:35–38.
3. Akiyama H, et al. J. Dermatol. 2004;31:529–34.
4. Skog E, et al. Br. J. Dermatol. 1983;109:77–83.
5. Drolshagen C and Schaffer D. Poster. 1999. SAWC Anahiem.
6. Smith & Nephew Data on file #091101. 2009.
7. O’Meara, S. et al. Cochrane database Syst. Rev. 1, CD003557 (2014).
8. Ormiston MC and Fox J. Br. Med. J. (Clin. Res. Ed). 291, 1424–1425 (1985);
9. Hansson C, et al. Int. J. Dermatol. 37, 390–396 (1998);
10. Gottardi, W. in Disinfection, sterilization and preservation (ed. Block, S. S.) 152–166 (Lea and Febiger, 1991);
11. Cooper, R. a. Iodine revisited.Int. Wound J. 4, 124–37 (2007);
12. Johnson, A. Prof. Nurse 7, 60, 62, 64 (1991).
13. Smith & Nephew Data on file 2008; #0804006.
14. Zhou LH, et al. Br. J. Dermatol 2002;146, 365–74.

The biofilm barrier: a direct cause of non-healing chronic wounds¹

Biofilm is a cluster of attached bacteria embedded in a matrix of proteins and sugars which offers protection from host defences and antimicrobials.²

Anti-biofilm mode of action
Dual action to disrupt biofilm^3,4

It is suggested that the cadexomer micro-beads are able to dehydrate and directly destroy the biofilm structure.3	Once the cadexomer beads are able to breach the biofilm-specific matrix, the iodine can subsequently kill the exposed bacteria within the biofilm community.3

Watch the video

Superior efficacy against biofilm proven across different lab models 5-8

IODOSORB™ has a long history of effectiveness against biofilm with superior results compared to other topical antimicrobials such as PHMB,
silver and povidone iodine.⁹

In line with the biofilm experts’ recommendations⁹ on selecting an effective anti-biofilm dressing, IODOSORB has been tested and shown to be more effective than Aquacel[tm] Ag+ across five challenging and clinically relevant biofilm models.^5-8

References

1. Malone, M. et al. J. Wound Care 25,12, 20–25 (2016);
2. Burmølle, M. et al., FEMS Immunol. Med. Microbiol. 59,(2010);
3. Akiyama, H., et al. J. Dermatol. 31, 529–34 (2004);
4. Hill., E., et al. J Antimicrob. Chemother.1195-1206 (2010);
5. Fitzgerald, D. J. et al. Wound Repair Regen. 25: 13-24 (2016);
6. Schultz, G. & Yang. Poster presented at WUWHS Florence (2016);
7. Oates J.L. et al. Poster presented at SAWC, Atlanta.(2016);
8. Phillips PL et al. Int Wounds J (2013):1-15;
9. Schultz et al. Wound Repair Regen (2017); approved article.

Frequently Asked Questions about IODOSORB

How do I remove IODOSORB from the wound?

Remove the secondary dressing. If it is sticking to the IODOSORB, soak with sterile saline or water. To remove IODOSORB from the wound, simply flush it away with sterile saline or water. If there are any small remnants of IODOSORB left in the wound, they will be naturally degraded without causing any delay to healing or systemic reaction.

How can I tell when the IODOSORB needs changing?

IODOSORB will change from a dark brown to off white which indicates that all the iodine has been released. This indicates that it is time to change the IODOSORB. The number of dressing changes therefore depend on the levels of infection and exudate present in the wound.

Is there any risk of iodine absorption causing any problems for the patient?

Generally if you use IODOSORB within the guidelines of the prescribing information (up to a maximum of 150g a week) it is unlikely that there will be any significant iodine absorption and therefore any systemic side effects. However, IODOSORB should not be used in patients with severely impaired renal function or a past history of any thyroid disorder as they are more susceptible to alterations in thyroid metabolism with chronic IODOSORB therapy. It has been observed occasionally that an adherent crust can form when IODOSORB is not changed with sufficient frequency.

Can I use a secondary dressing to secure IODOSORB to the wound?

Yes, you can use any semi-permeable secondary dressing, or secure IODOSORB with bandages over a non-adherent piece of padding or gauze.

Does IODOSORB cause patient pain in what often is already a painful ulcer?

IODOSORB desloughs by absorbing and drawing away slough and exudate from the wound surface. This is not harmful but indicates that the product is working. Sometimes patients feel a warm or smarting sensation and this may be due to the drawing effect of the slough and exudate.

Will IODOSORB relieve ulcer pain?

Yes, it has been shown to. Often IODOSORB will relieve pain whilst in the process of desloughing the wound and killing bacteria. In clinical trials, pain reduction has been a well observed benefit for patients.

What organisms is IODOSORB effective against?

Because IODOSORB contains elemental iodine, it is effective against a wide range of pathogenic bacteria, fungi, yeasts which can delay wound healing. Iodine is also highly effective against Methicillin Resistant Staphylococcus Aureus (MRSA). There have been no reports of acquired resistance with iodine.

For how long can I use IODOSORB on a slow healing ulcer?

IODOSORB can be used for up to 3 months. At this stage if the ulcer still needs treatment a non-iodine containing product must be used for a minimum of one week before resuming treatment with IODOSORB.

What is the largest amount of IODOSORB I can use in a week?

150g of IODOSORB can be applied per patient per week. A single application should not exceed 50g. If more is needed, refer to the warnings on the relevant data sheet and prescribing information.

Can IODOSORB be used in patients who are sensitive to iodine?

No, this is not recommended.

Will IODOSORB delay wound healing as it contains an antiseptic?

No. In fact IODOSORB has been reported to accelerate healing in randomised controlled trials.¹⁴

References

¹ Gustavson B. Cadexomer Iodine: Introduction. In: Cadexomer Iodine. Fox JA, Fisher H, editors. Stuttgart: Schattauer Verlag 1983. p. 35-41

² Drosou A, Falabella A, Kirsner RS. Antiseptics on Wounds: An Area of Controversy. Wounds 2003 15(5): 149-66.

³ LeVeen HH, LeVeen RF, LeVeen EG. The mythology of povidone-iodine and the development of self-sterilizing plastics. SURGERY 1993 Feb; 176(2):183-190

⁴ Haughton W, Young T. Common problems in wound care: malodorous wounds. BJN 1995 4, (16):959-963

⁵ Thomas S. Treating malodorous wounds. Community Outlook, 1989 Oct :27-28,30

⁶ Falanga V. Iodine containing pharmaceuticals: a reappraisal. Proceedings of the 6th European Conference on Advances in Wound Healing. London: Macmillan Magazines Ltd 1997

⁷ Tröeng T, Skog E, Arnesjö B, Gjöres JE, Bergljung L, Gundersen J et al. A randomised multicentre trial to compare the efficacy of cadexomer iodine and standard treatment in the management of chronic venous ulcers in out patients. In: Cadexomer Iodine, Fox JA, Fisher H editors. Stuttgart:Schattauer Verlag 1983. p. 43-50

⁸ Hillstrom L. Iodosorb compared to standard treatment in chronic venous leg ulcers - a multi center study. Acta Chir Scand Suppl. 1988; 544: 53-56

⁹ Holloway GA. Johansen KH, Barnes RW, Pierce GE. Multicenter trial of cadexomer iodine to treat venous stasis ulcers. West J Med 1989;151: 35-38

¹⁰ Sundberg J. Poster presentation. The European Wound Management Association Conference, Milan, Italy 1997

¹¹ Mertz PM, Oliveira Gandia MF, Davis SC. The evaluation of cadexomer iodine wound dressing on methicillin resistant staphylococcus aureus (MRSA) in acute wounds. Dermatol Surg 1999; 25(2): 89-93.

¹² Sundberg J, Meller R. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. Wounds 1997; 9(3):68-86.

¹³ Gilchrist B, Should iodine be considered in wound management? J Wound Care 1997; 6(3): 148-50.

¹⁴ Jones V, Milton T. When and how to use iodine dressings. Nursing Times 2000; 96 (45 suppl):2-3

¹⁵ Collier, M. Recognition and management of wound infections. Worldwidewounds, January 2005.

¹⁶ Ormiston MC, Seymour MT, Venn GE,Cohen RI, Fox JA Controlled trial of Iodosorb in chronic venous ulcers. BMJ 1985; 291:308-310.

¹⁷ Skog E. et al A randomised trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers Br J Dermatol 1983; 109(1): 77-83.

¹⁸ Zhou L.H. Nahm W.K. Badiavas E, Yufit T and Falanga V. Slow release iodine preparation and wound healing: in-vitro effects consistent with lack of in-vivo toxicity in human chronic wounds. British Journal of Dermatology 2002; 146(3): 365-374

¹⁹ Mertz PM, Davis S, Brewer L, Franzen L. Can antimicrobials be effective without impairing wound healing? The evaluation of a cadexomer iodine ointment. Wounds 1994; 6(6): 184-93