Antiseptic medicines. Antiseptic for wound treatment

Antiseptics

Antiseptics(antiseptica) in the treatment of stomatitis are used mainly in the form of rinsing, lubricating, and less often - in the form of inhalation (inhalation). The effectiveness of these agents in the oral cavity cannot be considered proven.

Antiseptics are prescribed to reduce the bacterial flora of the oral cavity or destroy pathogenic species of bacteria.

Most often, in the treatment of the mucous membranes of the oral cavity, those substances are used that, upon hydrolysis, release elements that have a disinfecting effect. Agents that remove free oxygen, hydrogen peroxide, and potassium permanganate are widely used. These medications act primarily on organic substances, bacterial protoplasm, toxins, bacterial exo- and endoenzymes.

Below is a brief description of the most commonly used antiseptics for inflammation of the oral mucosa.

Silver salts used in the form of silver nitrate (argentum nitricum). Silver nitrate is used in aqueous solutions of various concentrations or in a substance as a keratoplastic, cauterizing, astringent. The disinfecting power of silver is significant: in an aqueous solution it is lower than sublimate, but in blood serum and in protein compounds it increases. Upon contact with purulent secretion, lactic silver is formed, which has a high disinfecting power. However, chemically prepared silver lactic acid preparations are not very bactericidal. Solutions of silver nitrate are weak - 0.5-1%, medium - 2-4%, strong - 30-50%. It should be noted that with prolonged use, these solutions can have a carcinogenic effect: excessive reproduction and degeneration of the epithelium.

Zinc salts are used in the form of zinc chloride and zinc oxide. Zinc chloride (zincum chloratum) is used in solutions usually no higher than 10-15% as a cauterizing and disinfectant substance. The antiseptic effect of weak solutions of zinc chloride (5%) is questionable, and concentrated solutions irritate the mucous membrane.

Boric acid(ac. boricum) is a popular rinse in a 1-3% solution, which has low antiopeptic properties.

Chromic acid(ac. chromicum) 5-10% solution and lactic acid(ac. Iacticum) 25-50% solution is used for local cauterization of lesions and should be classified primarily as coriolitic, and in smaller concentrations - as corioplastic medicines, and not as antiseptics. The pain from cauterization with lactic acid decreases when it is mixed with iodoform to a paste-like state. Lactic acid has a cauterizing effect mainly on low-resistant inflammatory tissue, on ulcers or erosions and granulations; it has a weaker effect on healthy tissue of the mucous membrane. Therefore, lactic acid is widely used in the oral cavity in the presence of nonspecific ulcers.

Chromic acid has a strong cauterizing effect and is used in a 5% solution to lubricate ulcers. But since poisoning is possible when using it, it is better not to resort to using chromic acid.

Trichloroacetic acid(ac. trichloraceticum) cauterizes in a 1% solution.

Other acids, despite their antiseptic effect, are not used in the oral cavity, as they cause deep destruction.

Hydrogen peroxide(hydrogenium hyperoxydatum) is also a very common rinse, for which it is usually used in a 3% solution obtained by diluting a tablespoon of hydrogen peroxide in a glass of water. The action is based on the release of oxygen. The bactericidal effect in liquids containing protein is significantly reduced. The high bactericidal activity attributed at one time to hydrogen peroxide has not been confirmed by recent studies.

Potassium permanganate(kaliura permangani-cum) is used for rinsing in the form of a light purple solution (1:10,000, 1:20,000). In stronger solutions (4%) it has a strong disinfectant effect: it kills plague bacillus spores, promotes the rejection of necrotic tissue, and is used to cauterize ulcers. Strong oxidizing agent.

The action of potassium permanganate is based on reduction by organic substances. Solutions of potassium permanganate have strong deodorizing properties.

Potassium chloride salt(kalium chloricum), or Bertholet's salt, in a 3% aqueous solution was at one time widely used for ulcerative stomatitis, and for stomatitis of mercury origin it was even considered a specific remedy. However, due to its high toxicity and the risk of poisoning if accidentally swallowed, potassium chlorate is not recommended for use.

Chloramine is a strong antiseptic that, in the presence of organic substances, releases active chlorine. Chloramine is characterized by low toxicity and at the same time, in terms of bactericidal power, it exceeds the effect of carbolic acid. Contains 25-29% active chlorine. When exposed to tissue, it releases active chlorine and oxygen. For rinsing, chloramine is used in a 0.5-1.5% solution, for lubricating the mucous membrane - in a 2% solution.

Chloramine is of particular importance in the treatment of skin and mucous membrane lesions caused by blister toxic substances. The use of chloramine for these lesions is based on its properties partly to oxidize toxic substances and partly to bind, converting them into non-toxic compounds.

Borax(borax) - a weak antiseptic that also has an astringent effect on the oral mucosa; used for lubrication in a 3-10% solution. Often prescribed for canker sores and thrush.

Resorcinol(resorcinum) is an antiseptic of the phenol group. Used to treat gum pockets. Aqueous and alcohol solutions 2-5%.

Rivanol(rivanol) is an acridine drug. It is used as an active disinfectant with little irritation to fabrics in an aqueous solution of 1: 500, 1: 1,000, 1: 2,000.

Rivanol inhibits the lush growth of granulations. Used for rinsing, as well as in the form of applications.

Salvarsan(neosalvarsan) is used as a locally acting medication for nonspecific stomatitis, when the spirilla flora predominates (fusospirillum symbiosis).

Due to its deep action, local application of salvarsan gives a good therapeutic effect for spirillous stomatitis. In addition, in cases of mass distribution of Vincent's tonsillitis, lubrication of the mucous membrane with a 10% suspension of salvarsan in glycerin can be recommended for prophylactic purposes.

White streptocide(streptocidum album) is sometimes used as a powder or 10% suspension in glycerin for limited ulcerative processes on the oral mucosa; especially indicated in the presence of ulcerative processes in the regromolar area (difficulty in the eruption of wisdom teeth). The ulcer surface is powdered with white streptocide or a tampon with a glycerin suspension of white streptocide is placed on the ulcers once or twice a day. It should be borne in mind that these drugs can have a destructive effect on healthy granulations.

Diamond green(viride nitens) has strong bactericidal properties. It is used in the form of aqueous or aqueous-alcoholic solutions (0.05-0.1 per 100.0) and in the form of 1-2% ointments.

In dentistry, it is used primarily for impetiginous lesions of the facial skin and for pustular lesions of the perioral area.

In all cases of using antiseptic substances in the oral cavity, it is recommended to first rinse the mucous membrane with a weak soda solution (0.5-1%) in order to dissolve and remove mucus. It should be considered that this preliminary intervention not only increases the effect of antiseptics, but often makes their use unnecessary.

Furacilin(Furacilinum) diluted in alcohol 1: 500, frees granulations from pyogenic flora.

Phytoncides. B.P. Tokin discovered bactericides of plant origin in onions, garlic and other plants. The author called these bactericides phytoncides. Phytoncides turned out to be highly effective antiseptics, selectively affecting pyogenic microbes and not damaging tissues. We used them to treat ulcerative gingivitis and stomatitis and received positive results. The onion (garlic) is finely cut with a knife or grated. The resulting pulp is wrapped in gauze, applied to the gums and kept in the mouth for 10 minutes (or twice for 5 minutes). For ulcerative gingivitis, 4-5 such sessions are performed.

1. It is necessary to take onions or garlic that are well preserved, without signs of rotting even on the surface leaves. Autumn and winter onions and garlic have the greatest bactericidal power. As they are stored, towards spring and summer, their bactericidal properties decrease. Under poor storage conditions, the vital activity of onions and garlic stops, which means the formation of phytoncides, and thus they themselves can become a breeding ground for bacteria.

2. You can use any commercially available garlic, as long as it is of good quality. When it comes to onions, there are usually two types of onions on the market: some are slightly pinkish in color, others are coppery yellow. For treatment you need to take the latter.

3. Bulbs should be used rather than leaves (feathers), which have less bactericidal power.

4. The bottom of the bulb (the part where the roots form) and the entire adjacent half, rather than the upper part, are more bactericidal.

5. Please note that only freshly prepared onion or garlic gruel kills bacteria. It is enough for the paste to stand in the air for 10-15 minutes for the volatile bactericidal substances to disappear. This means that the gruel needs to be prepared quickly. You can use an ordinary grater for this purpose or construct a special apparatus. Success is determined by the speed of grinding and the degree of grinding of the material, i.e. it is important to create the maximum evaporation surface. You need to grind an onion or a clove of garlic, starting from the bottom and bringing it to about halfway.

6. It’s best to sprout the onion first (it doesn’t matter for garlic) so that barely noticeable roots appear on the bottom. You should not germinate too much. To do this, the day before, place the onion on a saucer with water, so that its bottom is wetted. The next day, the bulb can be used, regardless of whether roots have appeared or not.

Alcohol solution of iodine(5-10%) is used to disinfect the surgical field and the skin of the hands, lubricate the edges of the wound, cauterize minor abrasions and wounds.

Iodoform has a pronounced disinfectant effect. The drug dries the wound, cleans it and reduces decomposition. Prescribed in the form of powder, 10% ointment.

Lugol's solution consists of pure iodine and potassium iodide dissolved in alcohol or water. Used for washing purulent cavities.

Iodonate, iodolan, and iodopyrone are complexes of iodine with surfactant compounds. Used in a 1% concentration to treat the surgical field and disinfect hands.

Diocide- a chlorine-containing antiseptic with high bactericidal properties. Available in tablets No. 1 and No. 2. Used in a dilution of 1: 5000 (two tablets No. 1 and one tablet No. 2 are dissolved in 5 liters of warm boiled water) for treating hands, the surgical field, sterilizing rubber and plastic products, instruments, washing purulent wound The skin remains aseptic for at least 2 hours.

Hydrogen peroxide(3% solution) cleanses the wound well from pus and the remains of dead tissue due to the large amount of oxygen that is formed when peroxide comes into contact with tissue and blood. It has a hemostatic effect and is used for washing wounds, cavities, rinsing, and nasal tamponade.

Hydroperite- a complex compound of hydrogen peroxide and urea. Available in tablets. To obtain a 1% solution, dissolve 2 tablets of hydrogen peroxide in 100 ml of water. It is a substitute for hydrogen peroxide.

Potassium permanganate(potassium permanganate) - a disinfectant and deodorizing agent. In a 0.1-0.5% solution it is used to wash fetid wounds, in a 2-5% solution - as a tanning agent for the treatment of burns.

Formalin(0.5% solution) is used to disinfect instruments and rubber products.

Ethyl alcohol, or wine alcohol, has a disinfecting, drying and tanning effect. A 96% solution is used to treat hands, the surgical field, sterilize cutting instruments and equipment, suture material, and prepare anti-shock solutions.

Diamond Green and Methylene Blue- aniline dyes. They are used as antiseptics in the form of a 0.1-1% alcohol solution for burns and pustular skin lesions.

Furacilin used in a solution of 1: 5000 to treat purulent wounds and rinse cavities or as a 0.2% ointment. Has a detrimental effect on anaerobic infection.

Furagin is effective in a 1:13,000 solution for the treatment of wound infections and burns.

Silver nitrate used as a disinfectant for washing wounds, cavities, bladder in a dilution of 1: 500 - 1:1000; A 10% solution is used to cauterize excess granulations.

Chlorhexidine bigluconate used for treating the hands of medical personnel and the surgical field, sterilizing instruments.

Performic acid(pervomur) - an antiseptic solution, which is a mixture of hydrogen peroxide and formic acid. To treat hands, sterilize gloves and instruments, prepare a working solution: pour 171 ml of 30% hydrogen peroxide and 81 ml of 85% formic acid into a glass flask, shake the flask and place it in the cold for 1-1.5 hours. Stock solution dilute with 10 liters of boiled or distilled water.

Until the 19th century, most surgical operations ended in the death of the patient from infections brought in by healthcare workers. Fortunately, such a medical achievement as antiseptics has reduced the percentage of deaths from septicopyemia to a minimum. Modern surgery successfully uses various types of antiseptics, which we will discuss in this article.

What is antiseptic and why is it needed?

The relationship between pathogenic microbes and purulent inflammation of wounds was already suspected by ancient healers who unknowingly used natural components with anti-inflammatory properties. However, the real fight against surgical infections began in the second half of the 19th century, when the English physician J. Lister published an article in which he described his method of treating an open fracture using a 5% solution of carbolic acid. Since then, a new era in surgery has begun, where with the development of medicine, more and more new types of antiseptics appeared.

Antiseptics in modern terminology means a set of measures and manipulations, the purpose of which is the destruction of microorganisms, as well as their spores and toxins in tissues and macroorganisms. Along with this, the term “asepsis” is of great importance in surgery, which means a set of measures to prevent the development of pathogenic microbes in wounds. Aseptic techniques also include sterilizing surgical instruments and supplies. Like the discovery of anesthesia and blood groups, the types of asepsis and antisepsis discovered by surgery in the 19th century became one of the fundamental medical achievements of that time. It was from that period that surgeons began to more actively practice operations on the chest and abdominal cavity that were previously considered risky (almost 100% fatal).

The main types of antiseptics in modern medicine

Asepsis, of course, plays a huge role in surgery and often does not require additional measures, however, as practice has shown, a complete abandonment of antiseptic manipulations is impossible. Types of antiseptics in medicine can be divided according to the nature of the methods used and the method of application. In the first case, the types of antiseptics include:

• Mechanical antiseptics.
• Physical.
• Chemical.
• Biological.
• Mixed.

According to the method of application, chemicals and antiseptics are divided into:

• Local in the form of treating a specific part of the body. Local antiseptics can be superficial and deep. Superficial means cleaning wounds and injuries (washing with solutions, treating with powders, ointments, compresses), and deep antiseptics is the introduction of chemical and biological anti-infective drugs into the body through injections.
• General, implying infusion saturation of the body through the blood and lymph with antiseptic drugs (infusion of droppers).

Mechanical antiseptics

Mechanical antisepsis is carried out using surgical instruments and includes:

Physical antisepsis

Physical antiseptics includes a set of measures to prevent the proliferation of pathogenic microbes and the absorption of their metabolic products into the patient’s tissues. Physical types of wound antiseptics include the following:

Chemical antiseptic

Chemical antiseptics include measures to destroy pathogenic microbes in a wound or the patient’s body using chemicals, including:

Biological antiseptics

Biological antiseptics include agents of biological origin that can act both directly on microorganisms and indirectly. Biological antiseptics include:

Mixed antiseptic

Combined antiseptics use methods and means of all types of antiseptics in combination. The following are used as combined agents:

• Inorganic antiseptics.
• Synthetic analogues of biological agents.
• Synthetically produced organic substances.

Types of antiseptics for wood and other building materials

Various bacteria can cause processes of rotting and decomposition not only in the bodies of humans and animals, but also in building materials, such as wood. To protect wooden products in the interior and exterior from damage by insects and house fungi, different types of wood antiseptics are used in construction. They may be:

Antiseptics (from the Greek ἀντί anti "against" and σηπτικός sēptikos, "putrid") are antimicrobial substances that are applied to living tissue/skin to reduce the likelihood of infection, septicemia or putrefaction. Antiseptics generally differ from antibiotics in that the latter are able to be transported through the lymphatic system to kill bacteria within the body, and from disinfectants, which kill microorganisms found on nonliving objects. Disinfectants do not kill bacterial spores, such as those found on surgical instruments; this requires a sterilization process. Even sterilization cannot destroy prions. Some antiseptics are true disinfectants, capable of killing germs (bactericidal agents), while others are bacteriostatic agents, capable only of preventing or inhibiting their growth. Antibacterial agents are antiseptics that can act against bacteria. Microbicides that destroy viral particles are called virucides or antivirals.

Use in surgery

Some common antiseptics

Alcohols, usually ethanol (60-90%), 1-propanol (60-70%), and 2-propanol/isopropanol (70-80%) or mixtures of these alcohols, are commonly called "surgical alcohol" and are used to disinfect the skin , before the injection, often along with iodine (tincture of iodine) or some cationic surfactants (benzalkonium chloride 0.05-0.5%, chlorhexidine 0.2-4.0% or octenidine 0.1-2.0 %). Quaternary ammonium compounds include benzalkonium chloride, cetyl trimethylammonium bromide, cetylpyridinium chloride and benzethonium chloride. Benzalkonium chloride is used during some preoperative skin disinfection procedures (0.05-0.5%) and in antiseptic towels. The antimicrobial activity of quaternary compounds is inactivated by anionic surfactants such as soap. Related disinfectants include chlorhexidine and octenidine. Boric acid is used in suppositories to treat vaginal yeast infections, in lotions, as an antiviral to shorten the duration of sore throats, in creams for burns, and in trace amounts in contact lens solutions. Brilliant green is a triarylmethane dye that is still widely used as a 1% alcohol solution in Eastern Europe and the former Soviet Union for the treatment of minor wounds and abscesses. It is effective against gram-positive bacteria. Chlorhexidine gluconate, a biguanidine derivative, is used at concentrations of 0.5-4.0% alone or in lower concentrations in combination with other compounds such as alcohols as a skin antiseptic and a treatment for gum inflammation (gingivitis). The bactericidal effect is somewhat slow, but residual. It is a cationic surfactant similar to quaternary ammonium compounds. Hydrogen peroxide is used as a 6% solution (20 volumes) to clean and deodorize wounds and ulcers. Most often, 3% hydrogen peroxide solutions are used at home when treating scratches, etc. However, severe oxidation causes scarring and increases healing time in utero. Hydrogen peroxide steam at high concentrations (>50%) under a gentle vacuum can be used to sterilize surgical instruments with long, thin lumens within an hour without damaging temperature-sensitive electronics. Hydrogen peroxide and acetic acid create peracetic acid, which is more antimicrobial (antiseptic) than peroxide itself. The above peroxide antimicrobial agents are cheaper and decompose into harmless water and oxygen (and CO2, acetate, etc.) Iodine is usually used in an alcohol solution (the so-called tincture of iodine) or in the form of Lugol's solution as a pre- and postoperative antiseptic. Some people do not recommend disinfecting minor wounds with iodine due to concerns that it may cause scar tissue to form and prolong healing time. However, concentrations of 1% iodine or less have not been shown to increase healing time and are no different from saline treatment. The new iodine-containing antiseptic povidone-iodine (iodophor, a complex of povidone, a water-soluble polymer, with triiodide anions I3− containing about 10% active iodine) is significantly better tolerated, without adversely affecting wound healing, and leaving a residual active iodine, or permanent effect . The great advantage of iodine-based antiseptics is their broad coverage of antimicrobial activity, killing all major pathogens and, given enough time, even spores, which are considered the most difficult form of microorganisms to inactivate by disinfectants and antiseptics. Manuka honey is recognized by the FDA as a medicinal product for the treatment of wounds and burns. Active +15 is equivalent to a 15% phenol solution. Mercurochrome is not recognized as safe and effective by the FDA due to concerns about its mercury content. Other obsolete organomercury antiseptics include bis-(phenylmercuric) monohydrogenborane (Famosept). Octenidine, a cationic surfactant and bis-(dihydropyridinyl)-decane derivative, is used at a concentration of 0.1-2.0%. Its action is similar to quaternary ammonium compounds, but the compound has a slightly broader spectrum of activity. Octenidine is now increasingly used in continental Europe as a replacement for quaternary ammonium compounds (QACs) and chlorhexidine (relative to its slow action and the presence of carcinogenic impurities 4-chloroaniline) on skin soaked in water or alcohol, on mucous membranes, and as an antiseptic for wounds. In aqueous formulations, the substance is often enhanced with the addition of 2-phenoxyethanol. Phenol is a bactericidal agent in a concentrated solution, and inhibitory in weaker solutions. It is used as a "scrub" during pre-operative manual cleaning, and in powder form as an antiseptic baby powder for healing the belly button. Also used in mouthwashes and throat lozenges, it has an analgesic effect as well as an antiseptic. Example: TCP. Other phenolic antiseptics include thymol (sometimes used in dental surgery), hexachlorphene, triclosan, and sodium 3,5-dibromo-4-hydroxybenzenesulfonate (Dibromol). Polyhexanide (polyhexamethylene biguanide, PHMB) is an antimicrobial compound suitable for clinical use in critically colonized or infected acute and chronic wounds. Physicochemical actions on the bacterial membrane prevent or inhibit the development of resistant bacterial strains. Sodium chloride (salt) is used as a general cleanser and as an antiseptic mouthwash. Its weak antiseptic effect is due to the hyperosmolarity of the solution above 0.9%. Sodium hypochlorite has been used in the past, in diluted neutralized form, and in combination with boric acid in Dakin's solution. Calcium hypochlorite was used by Semmelweis as "bleach" in his revolutionary fight against puerperal fever. Sodium bicarbonate (NaHCO3) has antiseptic and disinfectant properties. Balsam of Peru is a mild antiseptic.

Evolving resistance

With prolonged exposure to antibiotics, bacteria can develop so much that the antibiotics no longer cause damage to them. Bacteria can also develop resistance to antiseptics, but the effect is usually less pronounced. The mechanism by which bacteria evolve may change in response to different antiseptics. Low concentrations of antiseptic may stimulate the growth of a bacterial strain that is resistant to the antiseptic, while a higher concentration of antiseptic would simply kill the bacteria. In addition, using an excessively high concentration of antiseptic may cause tissue damage or slow down the wound healing process. Therefore, antiseptics are most effective when used in the correct concentration—a high enough concentration to kill harmful bacteria, fungi, or viruses, but a low enough concentration to avoid tissue damage.

Antiseptic(or antiseptics) are products that are used for antimicrobial effects on the skin and mucous membranes. Unlike antiseptics, disinfectants agents (or disinfectants) are used to destroy microorganisms on various environmental objects (surgical instruments, dishes, walls of the operating room, disinfection of water, bed linen, clothing, etc., etc.). Thus, the fundamental difference between antiseptics and disinfection lies in the answer to the question “what are we treating?”

Taking into account the above definitions, it becomes clear that the same substance can well be used both as an antiseptic and as a disinfectant (you can treat your hands with a solution of ethyl alcohol, or you can dip a scalpel in it).

Antiseptics can be preventive(hand treatment, treatment of fresh wounds to prevent infection, skin treatment before surgery, etc.) and therapeutic(treatment of already infected wounds and mucous membranes).

We have repeatedly emphasized the fact that the local use of chemotherapeutic agents often does not allow the creation of a high concentration of an antimicrobial substance, which is a determining factor in the mechanism of formation of antibiotic resistance. Confirmation of this can be observed at every step: the same famous solution of furatsilin, which is currently practically ineffective against most actual bacteria.

The fundamental feature of a good modern antiseptic is that, firstly, it has a very wide spectrum of microbicidal action (antiviral, antifungal, and antibacterial) and, secondly, it is used specifically as an antiseptic (disinfectant), but nothing else (not applied systemically).

It is obvious that the skin is more resistant to the damaging effects of chemicals (of course, in comparison with oral and parenteral administration), which makes it possible to create sufficiently high concentrations of a chemotherapeutic agent with minimal risk of developing microbial resistance. All this creates the preconditions not only for effective prevention, but also for effective treatment, which often makes it possible to do without, for example, the use of antibiotics.

The number of drugs used for antiseptics and disinfection is huge, but we will allow ourselves only a brief overview of the main and most commonly used drugs, focusing on drugs that are needed for therapeutic and prophylactic use at home.

All antiseptics and disinfectants can be divided into three main groups :

• inorganic substances- acids, alkalis, peroxides, individual chemical elements (bromine, iodine, copper, mercury, silver, chlorine, zinc) and their derivatives (again, inorganic);
• organic substances- aldehydes, derivatives of alcohols and phenols, acids and alkalis, nitrofurans, quinolines, dyes and much more. The main thing is synthetic substances of organic nature;
• bioorganic substances- preparations of natural origin, i.e. obtained from actually existing biological objects (plant or animal raw materials, fungi, lichens).

Halogens and their derivatives

They are represented mainly by preparations based on chlorine and iodine.
To begin with, about chlorine…
Widely known (due to effectiveness and low cost) chloramine , which in solutions of different concentrations can be used both as an antiseptic and as a disinfectant.

• pantocide . Available in tablets and can be used to disinfect water (1 tablet per 0.5-0.75 l).
• chlorhexidine . Presented in a huge number of dosage forms: solutions (aqueous and alcoholic) in a wide variety of concentrations, aerosols, ointments, gels (including special dental ones), creams, emulsions, etc. In combination with other substances, it is included in some tablets used for resorption in the oral cavity for stomatitis, pharyngitis, etc. Chlorhexidine can be used as a mouth rinse, in the bladder, on wounds and on intact skin. In most cases it is well tolerated, there are no age restrictions. It is not recommended to use it together with iodine preparations - skin irritation often occurs;

• biclotymol . It is used mainly for diseases of the oral cavity. Available in the form of a spray and lozenges. Contraindicated for children under 6 years of age.

Widely known as an antiseptic 5% alcohol solution of iodine . Use is advisable for treating wound edges (but not the wound surface!), as well as small cuts and injections (when the wound surface is practically absent).

The use of iodine solutions should be treated with caution due to two circumstances. Firstly, molecular iodine from the surface of the skin can be partially absorbed, reach the systemic bloodstream and create concentrations that inhibit the function of the thyroid gland. Secondly, a 5% iodine solution quite often causes skin irritation, and the younger the child, the higher the risk of irritation.

Taking into account the two described circumstances, a standard 5% iodine solution is not recommended for use in children under 5 years of age. Some guidelines allow its limited use in children aged 1-5 years in diluted form (2-3% solution). Nevertheless, everyone is unanimous in the aspect that children of the first year of life cannot use a 5% iodine solution in any form.

At the same time, there are numerous iodine-containing antiseptics and disinfectants that are superior in their properties to the standard 5% solution - more effective and safe. These drugs, for the most part, if they irritate the skin, do so moderately; they exhibit a more intense and long-lasting antiseptic effect. However, systemic effects of iodine are possible, so caution should be used and instructions should be followed closely.

In particular, when using tools such as Iodinol And iodonate (solutions) molecular iodine is also formed, which can be absorbed into the blood.

Preparations that are a combination of iodine with a special substance - polyvinylpyrrolidone - are actively used.

Iodine bound to polyvinylpyrrolidone , loses its irritating effect on the skin and mucous membranes, and in addition is slowly released, which determines the long-term effect of the drug. The drugs are available in solutions, ointments, vaginal suppositories, and aerosols.

Povidone-Iodine

Povidone-Iodine

Aquazan, solution Betadine, solution, ointment, liquid soap, vaginal suppositories Betadine, solution, vaginal suppositories Brownodin B. Brown, solution, ointment Vokadin, solution, ointment, vaginal tablets Yod-Ka, solution Iodixol, spray Iodobak, solution Iodovidone solution Iodoxide, vaginal suppositories Iodosept, vaginal suppositories Iodoflex, solution Octasept, solution, aerosol Povidin-LH, vaginal suppositories Povidone-Iodine, solution, ointment, foam solution Povisept, solution, cream Polyiodine, solution Early stop, ointment

A conversation about iodine preparations would be incomplete without mentioning solution Lugol .

In just a little while, Lugol's solution will turn 200 years old - the French doctor Jean Lugol proposed it in 1829 for the treatment of tuberculosis! The composition of Lugol's solution includes iodine (1 part), potassium iodide (2 parts) and water (17 parts). Lugol's solution in glycerin is also available.

Lugol's solution is still actively used (by some doctors in countries with developing healthcare) to treat the mucous membranes of the oropharynx for tonsillitis and pharyngitis. Modern medicine considers such treatment unjustified (especially in children), primarily because the therapeutic effectiveness is in doubt, and the significant and potentially dangerous intake of iodine into the systemic bloodstream, on the contrary, does not raise any doubts.

And lastly, to complete the conversation about iodine preparations. The irritating effect of iodine on the skin is often used to implement the so-called. distracting procedures. The latter, in most cases, is the process of applying drawings to the skin using a 5% iodine solution - most often drawing iodine nets (on the back with acute respiratory infections, on the buttocks after injections, etc.). The mentioned method of “treatment”, firstly, has nothing to do with civilized medicine, secondly, it obviously carries a risk associated with excessive intake of iodine into the body, and thirdly, it is an effective example of calming psychotherapy for this purpose. , who, in fact, is engaged in drawing.

Oxidizing agents, acids, aldehydes and alcohols

Oxidizing agents are capable of releasing atomic oxygen, which in turn has a detrimental effect on microorganisms. Two oxidizing agents are widely known and actively used (although no one thinks about the fact that they are oxidizing agents): hydrogen peroxide and potassium permanganate (popularly known as potassium permanganate).

Peroxide hydrogen is produced mainly in the form of a 3% solution. Used as an antiseptic for treating skin and mucous membranes. It is also used as a hemostatic agent. Modern recommendations consider it advisable to treat the edges of the wound, but do not provide for contact of hydrogen peroxide with the wound surface: the antiseptic effect is beyond doubt, but it has also been proven that such treatment has a negative effect on healing time. Regarding the timing of stopping bleeding: with intense bleeding, hydrogen peroxide is ineffective, with moderate bleeding, pressure on the wound is enough to stop it.

In recent pseudoscientific literature, a lot of advice has appeared on the non-standard (to put it mildly) use of hydrogen peroxide - it is used orally and even administered intravenously for the purpose of rejuvenating the body and total recovery. The authors of the recommendations very convincingly (for those without medical education) describe the advantages of such methods, but their scientific justification does not exist. It is not our task to debunk myths, but we would like to convincingly ask parents not to use hydrogen peroxide in an unconventional way, at least in relation to children (especially since they will certainly do without rejuvenation).

Hydroperite is a compound of hydrogen peroxide and urea. It is produced in tablets, which are dissolved in water before use - the resulting solution is identical in its properties to hydrogen peroxide. Many parents are convinced that a tablet of hydroperite per glass of water is the “correct” solution of hydrogen peroxide.

Let us explain: a solution corresponding to 3% peroxide is 1 tablet of 0.5 g per 5 ml of water! There are also tablets of 0.75 and 1.5 g (it is clear that 1.5 g is per 15 ml of water).

Potassium permanganate . It appears as red-violet crystals (sometimes powder). Let's dissolve well in water. Pharmacological guidelines recommend the use of potassium permanganate for washing wounds, rinsing the mouth, and douching. Concentrated solutions (2-5%) are used to lubricate ulcerative surfaces.

Most parents believe that the main purpose of using potassium permanganate at home is to disinfect water prepared for bathing a baby. In fact, this is far from the case. The minimum concentration of potassium permanganate that has antiseptic activity is a 0.01% solution. At the same time, the standard recommended disinfectant concentrations are 0.1% and higher.

Let us translate for those who are not particularly good at mathematics: a 0.01% solution is 1 g per 10 liters of water, 0.1% is, respectively, 10 g per 10 liters!

Thus, by adding a “gramule” of potassium permanganate to the water and making it (the water) pale pink in color, parents are not disinfecting anything, but are just putting a tick on their own conscience - our baby, they say, is now in no danger.

Bornaya acid . Available in the form of powder, solutions of different concentrations, ointments. Included in some combination products for external use (together with zinc, petroleum jelly, etc.).

A 2% aqueous solution is used for conjunctivitis, alcohol solutions of different concentrations are prescribed for otitis (drop into the ear canal or moisten the ear canal).

Currently, the use of boric acid is limited in many countries, since numerous side effects associated with the toxic effects of the drug have been identified - vomiting, diarrhea, rash, headache, convulsions, kidney damage. All this more often occurs with an overdose (treatment of large areas of skin, for example) or prolonged use. However, the risk is always present, which is why most doctors consider boric acid to be an outdated and unsafe drug. In any case, the drug is contraindicated during pregnancy, breastfeeding and children in the first year of life.

Formaldehyde (a common synonym is formaldehyde). Widely used in medical institutions, it is part of some combined disinfectants. Has nothing to do with outpatient pediatrics.

Ethyl alcohol . As an antiseptic, it is most advisable to use a 70% solution. Can be used to treat hands and skin (around the wound, before injections). Even from the surface of intact skin it enters the systemic bloodstream. Inhalation of alcohol vapor is accompanied by a similar effect. Exactly In children, alcohol poisoning is especially dangerous due to severe respiratory depression.

Use as an irritant (compresses, rubbing, lotions, etc.) and to combat elevated body temperature (wiping the skin) in children is risky and is currently not recommended (more often strictly prohibited) by health authorities in most civilized countries.

Metal salts and dyes

Protargol (silver proteinate). Used in the form of a 1-5% solution as an antiseptic: lubricating the mucous membranes of the respiratory tract, washing the bladder and urethra, eye drops.

Currently, pharmacological reference books consider protargol to be an outdated remedy with very moderate effectiveness, completely incomparable with that of modern antibacterial agents. Nevertheless, in some regions protargol is still widely used by doctors who believe in its effectiveness. The frequency of use is largely explained by the psychotherapeutic effect - the very phrase “silver treatment” has a healing effect.

Collargol (colloidal silver). In solutions of different concentrations (0.2-5%) it is used for the same indications and with the same moderate results as protargol.

Zinc sulfate . In the form of a 0.25% solution, it is sometimes used as an antiseptic for conjunctivitis (eye drops). However, it is more often used in tablets to treat certain diseases associated with zinc deficiency in the body.

Zinc oxide . Actively used in the treatment of many skin diseases. It is used both independently and in combination with other drugs. Included in powders, ointments, pastes, liniments.

Diamond green (popular name - brilliant green). A widely known and equally actively used ineffective antiseptic. The breadth of application, however, is limited to the territory of the former Soviet Union. Available in the form of alcohol solutions (1 and 2%), as well as in the form of pencils.

Methylene blue . Available in both alcohol and aqueous solutions. Alcohol solutions (1-3%) are used to treat the skin for antiseptic purposes, and cavities (for example, the bladder) are washed with water solutions. The effectiveness of application as an external agent is equivalent to that of brilliant green.

Methylene blue is used not only as an antiseptic. Its solutions are very effective for certain poisonings: hydrogen sulfide, carbon monoxide, cyanide (injected intravenously during treatment).

Magenta . Dye, aqueous solutions of bright red color. It is not used independently, but is part of some combined antiseptics, in particular fucorcin (a combination of fuchsin, boric acid, phenol, acetone, resorcinol and ethanol). Indications for the use of fucorcin are fungal and pustular skin diseases, abrasions, cracks, etc.

The fucorcin solution (thanks to fuchsin) also has a bright red color. Thus, parents are given the opportunity to widely use a wide variety of ineffective, but completely safe dyes, which means, in accordance with their artistic taste, they can paint their children green, blue and red.

Bioorganic substances

Chlorophyllipt . The drug, which has antibacterial activity, is a mixture of chlorophylls obtained from eucalyptus leaves. In some situations, it is capable of exhibiting bactericidal activity against antibiotic-resistant bacteria. For topical use, oil and alcohol solutions of various concentrations are used.

During use, quite severe allergic reactions are possible.

Sodium usinate . Contains usnic acid, which is isolated from a special type of lichen. Has moderate antibacterial activity. Available in the form of an alcohol solution, as well as solutions in castor oil and fir balsam. The latter is of some pediatric interest - many note its effectiveness in treating cracked nipples in nursing mothers.

Lysozyme . One of the most important components of immune defense. Enzyme. Obtained from chicken egg white. Wipes moistened with lysozyme solution are used in the treatment of purulent wounds, burns, and frostbite. Also used in the form of eye drops.

Ectericide . A transparent yellow oily liquid with a specific odor of fish oil (from which, in fact, the ectericide is obtained).

Has antibacterial activity. Used to treat festering wounds, burns, ulcers, fistulas, etc.: wash, apply wet wipes. It is often used in the form of nasal drops - mainly for prolonged runny nose of an infectious nature.

Flowers marigold . A common synonym is calendula flowers. An infusion of flowers is used as an antiseptic for inflammatory diseases of the oral cavity. Calendula tincture in 70% ethanol is also available. Indications, precautions and meaning of use are the same as for 70% ethyl alcohol.

Other antiseptics and disinfectants

Decamethoxin . Has antibacterial and antifungal effects. Available in the form of ear and eye drops, as well as in the form of tablets intended for the preparation of solutions. Used for the treatment of otitis and conjunctivitis, for rinsing with bacterial and fungal infections of the oral cavity, for lotions for skin diseases, for rinsing the bladder, etc.

Decamethoxin is well tolerated, there are no contraindications for use (except for hypersensitivity).

Miramistin . A complete antiseptic - it is active against viruses, bacteria, fungi, and protozoa.

The main indication for use is the prevention of suppuration and treatment of purulent wounds. Used for otitis, conjunctivitis, sinusitis, and a wide variety of inflammatory processes in the oral cavity.

Available in solutions (usually 0.01%) and as a 0.5% ointment.

Ichthyol . It is almost impossible to explain what ichthyol is and where it comes from - the simplest available explanation looks something like this: “ichthyol is obtained from resins formed during the gasification and semi-coking of oil shale.” Ichthyol is a thick black liquid with a very specific odor. It has completely insignificant antiseptic properties. According to the behests of grandmothers who believe in its miraculous effectiveness, it is used in the form of an ointment to treat various skin diseases. Not used by civilized medicine.

Octenidine (octenidine hydrochloride). A modern broad-spectrum antiseptic. It does not penetrate into the systemic bloodstream even when treating wounds, which determines its uniquely low toxicity. It makes no sense to describe the indications for use - it can be used in almost all situations where an antiseptic effect is necessary (with the exception of dripping into the ear and rinsing the bladder). It is rational as a means of primary treatment of wounds (pricks, abrasions, cuts) at home.

Available in solution, in bottles with various attachments (for spraying, for insertion into the vagina).

Can be used in children of any age, during pregnancy and breastfeeding. In the latter case, if treatment of the nipples is necessary, care must be taken to ensure that the drug does not get into the child’s mouth.

In finished dosage forms, octenidine is usually combined with phenoxyethanol(also an antiseptic, but with preservative properties).

Quaternary ammonium compounds. A group of widely used antiseptics and disinfectants. The most famous - benzalkonium chloride , which, in addition to its antimicrobial effect, also has spermicidal activity (i.e., the ability to kill sperm), and therefore is used as a local contraceptive.

Benzalkonium chloride is included in many topical medications intended for wound treatment, absorption in the oral cavity, etc.

Benzalkonium chloride

Benzalkonium chloride

Benatex, vaginal gel, vaginal suppositories, vaginal tablets Virotek Intim, solution Virotek Clinic, solution Dettol spray Katamin AB, solution Katapola solution Katatcel, paste for external use Contratex, vaginal suppositories Line-bio, liquid Lizanin, solution Maxi-Dez, solution Micro 10+, solution Rokkal, solution Septustine, solution Spermatex, vaginal suppositories Pharmaginex, vaginal suppositories Pharmatex, vaginal cream, vaginal suppositories, tampons for intravaginal administration Erotex, vaginal suppositories

Another well-known drug in this group is cetrimide . Its combination with benzalkonium chloride is available in the form of a cream, indications for use are diaper rash, diaper dermatitis, burns.

(This publication is a fragment of the book by E. O. Komarovsky adapted to the format of the article