Povidone-iodine in pediatric surgery: efficacy and safety of various dosage forms (literature review)

Background . Povidone-iodine is widely used in surgical antisepsis; however, its efficacy and safety depend on the dosage form, concentration, and type of tissue being treated. Direct comparative studies in children are limited, and a significant portion of clinical data has been obtained in adult populations. The high incidence of purulent-inflammatory diseases of the perianal area and increasing microflora resistance contribute to prolonged wound healing. Objective . The aim of this study was to systematize data on the efficacy, safety, and areas of application of various povidone-iodine dosage forms in pediatric surgery, taking into account patient age, tissue type, concentration, and exposure regimen. To evaluate the clinical and economic effectiveness of using multicomponent polyethylene glycol-based ointments in the topical treatment of patients with purulentinflammatory diseases of the anorectal area. Materials and methods . A structured critical review of PubMed/MEDLINE publications, international guidelines, systematic reviews, randomized and observational studies, and studies on neonatal safety was conducted. Pediatric data were analyzed separately from adult studies. A quantitative synthesis was not performed due to the clinical and methodological heterogeneity of the sources. For key clinical sources, a design-specific risk of bias and directness of evidence assessment was additionally performed. The search depth was 30 years. Research results . Povidone-iodine has a broad antimicrobial spectrum and acts on multiple cellular targets; no convincing evidence of clinically significant acquired resistance was obtained. For intact skin preparation, the evidence base primarily relates to alcohol-based antiseptics. Within the group of drugs, aqueous forms can be used in a wider range of tissues and clinical sites, as they are used on mucous membranes, selected wound and burn surfaces, around drains, and in some irrigation protocols. Physicochemical and microbiological studies indicate that certain 7.5 % solutions may exhibit comparable or higher in vitro microbicidal activity compared to 10.0 % preparations. Among the sources included in the review, no direct clinical studies specifically designed to demonstrate non-inferiority of a 7.5 % solution compared to a 10.0 % solution were identified. The main age-specific limitation is the systemic iodine load in newborns and premature infants, especially when treating a large area, with repeated applications and prolonged contact. Conclusion . Aqueous forms of Povidone-iodine are applicable across a wider range of clinical sites in pediatric surgery than alcohol-containing forms. The aqueous 7.5 % solution is a standalone dosage form and should not be considered less active solely due to its lower nominal concentration. Its practical value is determined by registered indications, dilution regimens, and free iodine content. Among the sources included in the review, no direct clinical studies were identified specifically designed to demonstrate the non-inferiority of a 7.5 % solution compared to a 10.0 % solution. The choice of drug is determined by the tissue type and exposure regimen, and in newborns and premature infants, it is further limited by the risk of systemic iodine loading.