Reactions Weekly | 2021
Polihexanide
Abstract
Tissue degeneration, acute pain syndrome and acquired resistance: case report A 72-year-old man developed tissue generation, pain syndrome and acquired drug resistance during treatment with polihexanide for a soft-tissue bacterial infection and osteomyelitis. The man underwent radiotherapy before 35 years for the treatment of cervical cancer, which resulted in the development of widespread osteomyelitis in the hip and right femur. He had been paraplegic from past 20 years. In March 2017, he developed an eschar for which he received treatment with Manuka honey. In late May 2017, he underwent surgical debridement. By late June, the wound was observed to be increased in size with progression of soft tissue infection. At that time, the use of Manuka honey was discontinued due to worsening of the condition and micropore particle technology (MPPT) was initiated. Consequently, wound healing was observed along with resolution of soft tissue infection and osteomyelitis. By week 12, the treatment goal of MPPT for wound healing and removal of soft tissue infection was achieved. The MPPT was discontinued and after 2 days, the treatment protocol was changed to polyhexanide [prontosan] 0.1% gel, which was applied once on every other day. The gel also consisted an undecylenamidopropyl betaine surfactant. The gel was applied with the help of cellulose-based gelling fiber ribbon. At day 6 of polyhexanide treatment, there was appearance of froth, which was indicative of gas entering the wound through holes in the fascia and underlying infected bone. Over the subsequent 4 days, the froth further grew in amounts. The regression of the granulation tissue was noted. Areas which had already undergone strong tissue maturation and regeneration previously, showed loss of bud formation, and loss of structure and vitality. The overall marked regression was indicative of tissue degeneration. The appearance of wound edges was changed from bulging, whitish-pink to a shriveling appearance with red to purple colouring. The changes and regression of hip bone fascia resulted in increased direct exposure of the underlying infected bone, which led to increased difficulty for granulation tissue to migrate across as well as increased release of infective material into the wound. The release of increased infective material was also attributed to the development of acquired cross-resistance by soft-tissue infection causing bacteria towards polihexanide. Exudate and slough changed in color from pale yellow to dark brown to black and increased in volume. On day 10 of polyhexanide treatment, he developed an acute pain syndrome. Polihexanide was discontinued. During the 7-day wash-out period, the effects caused by polihexanide were persistent. The man resumed once daily application of MPPT. After 3 weeks of daily MPPT application, there was renewed regeneration of granulation tissue, reduction of wound exudate and gradual closing of the wound. He continued daily use of MPPT for 8 months. During 8-month period, the wound to improve and reduce in size; however, closure of wound was not achieved due to osteomyelitis. On July 2018, he was scheduled for surgery to close the wound by tertiary intention and remove parts of the infected bone. The outcome of operation was successful.