Kramer Axel, Assadian Ojan, Koburger-Janssen Torsten
Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany.
Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK.
GMS Hyg Infect Control. 2016 Dec 14;11:Doc24. doi: 10.3205/dgkh000284. eCollection 2016.
The objective of this standardised experimental study was to investigate the antimicrobial efficacy of the combination of chlorhexidine digluconate (CHX) and the anti-inflammatory pro-vitamin dexpanthenol, which stimulates wound-healing, in the form of Bepanthen Antiseptic Wound Cream, in order to rule out possible antagonistic combination effects of CHX and the alcohol analogue of pantothenic acid (vitamin B5) dexpanthenol. Testing was carried out using the quantitative suspension test at conditions simulating wound bio-burden. Test strains included (ATCC 10541) and (ATCC 10231) in accordance with the standard methods of the German Hygiene and Microbiology Society with the following three organic challenges: i) cell culture medium MEM with Earle's salts, L-glutamine and 10% foetal calf serum (CCM); ii) 10% sheep's blood; iii) or a mixture of 4.5% albumin, 4.5% sheep's blood and 1% mucin. For methodological reasons, the wound cream was tested as a 55% dilution, prepared with 1% Tween 80 (equivalent to a content of 0.275% CHX instead of 0.5% as in the original preparation). CHX 0.275% was tested as control in an aqueous solution and in 1% Tween 80. Additionally, 1% Tween 80 was tested in order to rule out an interfering effect of the dilution medium. A combination of 3% Tween 80, 3% saponin, 0.1% histidine, 0.3% lecithin, 0.5% Na-thiosulphate and 1% ether sulphate was identified as the most appropriate neutraliser during the experiments. Exposed to CCM or 10% sheep's blood, the tested wound cream fulfilled the requirements for a wound antiseptic against both test species with ≥3 log reduction at 10 minutes. Even at the the worst-case challenge test with 4.5% albumin, 4.5% sheep's blood and 1% mucin, the requirement for a ≥3 log reduction was met after 24 hours of exposure. Interestingly, the aqueous solution of 0.275% CHX tested as control did not achieve the antimicrobial efficacy of the combination of CHX and 5% dexpanthenol. 1% Tween 80 was ineffective against both test species. Bepanthen Antiseptic Wound Cream achieves the bactericidal and fungicidal efficacy required for a wound antiseptic under three different challenges, despite dilution to 55% of the original preparation. So far, the addition of dexpanthenol was intended to support wound healing. However, our results indicate that the antiseptic efficacy of CHX is synergistically increased by adding 5% dexpanthenol. Acknowledging the antimicrobial and residual efficacy of CHX, and bearing in the mind the contraindications to CHX (allergy and anaphylaxis), the tested wound cream should be regarded as better suitable to be used as wound antiseptic than preparations on basis of CHX alone.
这项标准化实验研究的目的是调查葡萄糖酸氯己定（CHX）与具有促进伤口愈合作用的抗炎维生素原泛醇（右旋泛醇）以拜耳万能伤口消毒软膏（Bepanthen Antiseptic Wound Cream）的形式联合使用时的抗菌效果，以排除CHX与泛酸（维生素B5）的酒精类似物右旋泛醇可能产生的拮抗联合效应。测试是在模拟伤口生物负荷的条件下使用定量悬浮试验进行的。根据德国卫生与微生物学会的标准方法，测试菌株包括金黄色葡萄球菌（ATCC 10541）和大肠杆菌（ATCC 10231），并设置了以下三种有机挑战：i）含有厄尔氏盐、L-谷氨酰胺和10%胎牛血清的细胞培养基MEM（CCM）；ii）10%羊血；iii）或4.5%白蛋白、4.5%羊血和1%粘蛋白的混合物。出于方法学原因，伤口消毒软膏按55%的稀释度进行测试，用1%吐温80配制（相当于CHX含量为0.275%，而非原制剂中的0.5%）。0.275%的CHX在水溶液和1%吐温80中作为对照进行测试。此外，还对1%吐温80进行了测试，以排除稀释介质的干扰作用。在实验过程中，3%吐温80、3%皂苷、0.1%组氨酸、0.3%卵磷脂、0.5%硫代硫酸钠和1%硫酸醚的组合被确定为最合适的中和剂。暴露于CCM或10%羊血中，测试的伤口消毒软膏在10分钟时对两种测试菌种均达到伤口消毒剂的要求，即减少≥3个对数。即使在4.
