Questions about Antiseptics

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Aug 3, 2000
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I have bought a few first aid kits over the years and I have augmented them with additional items from the pharmacy. Now I realize that I have several different types of antiseptics and I want to know what the difference is between them (ie: is one better in certain situations?) Here is he list of what I have:

Triple Antibiotic Ointment (Bacitracin-Neomycin-Polymyxin B) Comes in a cream and says its for minor cuts and scrapes.

Benzalkonium Chloride. Comes in a medicated towelette and is listed as an "Antiseptic/Germicide".

Iodine. Comes in both a medicated towelette and in a bottled liquid form. Listed as an "Antiseptic/Germicide".

Alcohol (Isopropyl). Comes in both medicated towelette and bottled liquid.

So what are the benefits of each one and why might I choose one over the other for a given type of injury? Are some of them redundant? Also all of them are listed for external use only, do I need something else for deep wounds/infections?
 
you have an assortment of antiseptics, the alcohol should not be used in open wounds. the triple antibiotic ointment may be used in open wounds, burns, cuts, but it would be best to wash the wounds with soap and water first then apply a sterile dressing on the wound after applying the ointment. the benzalconium is an older disinfectant, you can use it in dilute concentrations on open wounds but again best to clense the wound with soap and water first. the betadyne soln (not the scrub- which contains soap) can be used on open wounds as a disinfectant also, you may also use betadyne solution to decontaminate water, i think 10 drops per liter and wait 20 minutes, to create a mild disinfecting solution in which to soak burns, open wounds.

as far as treating an infection, topical treatments are modestly effective in treating only mild infections, for severe infections you would need systemic antibiotics.

alex
 
Your triple antibiotic contains neomycin. I can't remember what I saw about neomycin, but there is a precaution about how to use products that contain it. I saw the mention in a Backpacker magazine from earlier this year. Unfortunately I'm at work and the magazine is at home. Maybe you could find it at www.backpacker.com .
 
Basically, you shoudln't use any of these for wounds that have penetrated the dermis. the neosporin/bacitracin/polysporin ointments are ok for mild abrasions, minor lacerations (where the skin edges are fairly well approximated). Alcohol/Benzalkolonium/Betadine should generally only be used as a prep to clean intact skin. You can use betadine in wounds, but you should always use a diluted solution and follow it by irrigating the wound thoroughly. Betadine/Alcohol are both toxic to living tissues - your skin is pretty tough, but the structures below the dermis are more fragile and can be damaged by any prolonged contact w/ either solution. An example - a big nasty cut gets irrigated w/ lots of sterile saline or water(if available), but typically we don't put other stuff in there. An area of roadrash, minor scrapes, etc., can be scrubbed w/ betadine to remove debris and combat any bacteria that may be in the area, but this should be followed w/ a second cleaning of just soap & water to remove the betadine.

Sam
 
Carry a few alcohol swabs for cleaning the area around a wound and then apply Neosporen (sp?). This stuff is amazing...it helps healing on just about any kind of wound I have ever gotton.
You can also use it with some cotton balls for a good fire starter too.
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Ron,
Bremerton, Washington
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I looked through backpacker as coyotlviejo suggested. I didn't find any cautions about neomycin but I did find some tips on antiseptics.

Triple-antibiotic ointment (e.g. Neosporin, Mycitracin). Used for minor cuts. Not used for unbroken skin or for heavily bleeding cuts. To use wash w/ water, apply the ointment, cover w/ bandage or gauze.

Betadine/iodine. Dilute in water and use it to irrigate the wound. They suggest bringing a syringe to irrigate with.

I didn't find any mention of alcohol or benzalkonium chloride
 
Antibiotic ointments are not recommended for deep wounds because i) the ointment's oily substances can seal the wound surface creating anaerobic conditions (ideal for some dangerous bacteria) ii) some people could be allergic to some antibiotic substances iii) topical antibiotics are useless against viruses and fungi and many soil or other bacteria are resistant.

Alcohols are not very efficient antiseptics, some viruses and many bacteria, especially the endespore forming ones can survive the treatment. They are also more or less toxic to the tissues, especially in the open wounds. However it they are good cleaning substances able to remove some water insoluble contamination too. Use on intact or bruised only skin or around (but not in) the open wound. Ethyl alcohol is pretty much useless in less than 70% concentration, however above 70-75% the efficiency is declining again. The reason is that the very concentrated alcohol suddenly dehydrates the germs so they become a lot more resistant to many chemical and/or physical exposures.

Avoid anorganic iodine for open wound treatment. The stuff is very toxic to the tissues, the dead tissue due to excess iodine is excellent growth medium for some dangerous bacteria.
However Betadine is NOT anorganic iodine solution. This allows for lower iodine concentrations that's why you can use it on open wounds too. Iodine is a very broad spectrum antiseptic, it is effective against a large number of viruses, bacteria, fungi and parasites.

For water (especially drinking water) disinfection I would prefer some chlorine based substance over the betadine or any other iodine solution. For this purpose chlorine is much more effective than the diluted iodine.

Be aware that even small wounds, especially the deep punctured ones could be the entrances for germs causing very serious infections. Rabies is common amongst wild or feral animals, tularemia is another disease which could be contracted from handling or skinning smaller mammals (especially rabbits). Use gloves, or wash your hands thoroughly after skinning. Small bruises could be the entrances for infectious agents.
Ticks and less frequently other blood sucking arthropods could transmit infectious diseases too (Lyme disease etc.). Try to remove the ticks without squeezing them, use delicate tweezers and try to catch them as close to the skin surface as possible. After removing them apply iodine and try to rub it gently into the skin.
 
Littleknife's post is excellent. (Thanks Littleknife!)

Also, I recommend that you read the excellent discussion of these topics in the book Medicine For Mountaineering.
 
I'll try to find the article I was referring to and let you all know what it said. Maybe it wasn't even neomycin that the article referred to. Hope I didn't cause anybody to throw out their ointments...

Could I possibly have been confused?
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Camine con tranquilidad, sirva con humildad, y viva en paz.
 
I would assume that littleknife's advice is sound and reflects the experts' opinions, but I think it comes somewhat from a hospital/emergency room viewpoint. I have succesfully treated many cuts and scrapes in the last 50 years and have only gone to the hospital once. I think that 98% of all the injuries that you would need to treat with your first aid kit would be considered very shallow or superficial. You will primarily be treating injuries that would not get you in the door of the emergency room and you should understand this when you consider littleknife's advice. In particular I have found it very useful to slap on the Neosporin to prevent infection in minor cuts (often more scratches than cuts).

A common injury while hiking is forming and popping a blister. Last week my wife did that and ignored it. Soon the area started to get more generally inflamed. What helped was to cut away the problem area of her shoe, clean the area, apply Neosporin, and bandage it to keep out dirt. Although it would certainly be painful, if we'd been out in the woods without clean water to work with I would have taken a quick cleaning swipe at the area with an alcohol prep if that was all that was handy.

Other common wounds would be: that bug bite that you scratched to hard, the thorn scrapes on your arm, and that hand scrape where you slipped on the rocks. If you've got a clean paper towel and a canteen of clean water you've got your primary antiseptic tools. I've still had better luck supplmenting these with a little of the old triple-antibiotic ointment.

Even for cuts I often use the ointment. Typically I've cut myself less than 1/8" deep with my essentially clean pocket knife. I do my first wound cleaning by letting the cut bleed freely while I look for a good source of real clean water. I like to irrigate the cut out of a water tap or by pouring water into the wound from some hight. The idea is to flush out debris in the wound and to let the blood do some of the work. Then I wrap the wound with a lot of neosporin in the bandage. I emphasize that these are fairly trivial and rather clean wounds. Keep your tetanus shots up to date and get those deeper cuts properly looked after soon if you want to be safe and minimize scarring.


[This message has been edited by Jeff Clark (edited 06-11-2001).]
 
Jeff, you are absolutely right, for minor injuries go ahead with the triple antibiotic/Neosporin ointments. I was talking about deep wounds, both those which don't need stiches and those which need some first aid until getting to the ER.
 
<font face="Verdana, Arial" size="2">Originally posted by littleknife:

For water (especially drinking water) disinfection I would prefer some chlorine based substance over the betadine or any other iodine solution. For this purpose chlorine is much more effective than the diluted iodine.
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Hmmm ... I thought it had been proven a few years ago that chlorine definitely does not remove an acceptable number of some sort of pathogen. I think the research was focused on giardia, especially the cyst form, but I'm not certain. Iodine was found to be effective.

That is from very hazy memory, I'd be happy to be corrected. Worst of all, I could have it exactly backwards. There was definitely dicussion on rec.backcountry a few years ago of a particular study that compared iodine and chlorine.

 
Joe, you are right in a way.
I made a search on the net and gathered the following information.
For SHORT TERM USE iodine is more frequently recommended than the chlorine. However one of the sources claims that it is somewhat less effective against Giardia. Neither is really good against Giardia or Cryptosporidium cysts. The disadvantage of the iodine is that it can interfere with the normal thyroid gland function, that's why it is recommended for short term use ONLY. On the other hand iodine is less affected by the presence of some impurities.

Below you can find the appropriate excerpts and at the end of each of them the URL. Check it out, interesting tutorials.


Chlorine and iodine are somewhat effective in protecting against exposure to Giardia, but may not be effective in controlling Cryptosporidium. Therefore, use iodine or chlorine only to disinfect well water (as opposed to surface water sources such as rivers, lakes, and springs), because well water is unlikely to contain these disease causing organisms. Chlorine is generally more effective than iodine in controlling Giardia, and both disinfectants work much better in warmer water.
http://www.epa.gov/safewater/faq/emerg.html


If you have a choice of disinfectants, use iodine. Iodine's disinfectant activity is less likely to be reduced by un favorable water conditions, such as dissolved organic material in water or by water with a high pH, than chlorine.
http://www.gorp.com/gorp/health/wtrflfaq6.htm


Protozoan cysts are often present in surface waters. Because cysts are more resistant than bacteria and viruses, iodine and chlorine should not be relied upon to inactivate them. When water must be continuously disinfected because of the unacceptable quality of the supply, the possibility of sporadic contamination or the presence of cysts, a water treatment device incorporating filtration and disinfection should be used rather than short-term disinfection methods. …
Chlorine and iodine kill most disease-causing organisms and require short to moderate contact times. In fact, the use of chlorine on municipally treated water systems has virtually eliminated waterborne infectious diseases such as typhoid and cholera. Chlorine or iodine treatment alone, however, may not provide adequate protection against protozoa such as Giardia lamblia and Cryptosporidium parvum. If protozoa are present or suspected, it is recommended that the water be first passed through a filter with a 0.1-micrometre or smaller pore size to remove these parasites and then chemically treated with chlorine or iodine to kill bacteria and viruses.
Iodine disinfection of drinking water, however, should be reserved for emergency and occasional use (e.g., at a weekend cottage or in recreational vehicles). Iodine should not be used for long-term continuous disinfection because it is physiologically active, and ingestion in excessive amounts may be harmful.
http://www.hc-sc.gc.ca/ehp/ehd/catalogue/general/iyh/disinfection_devices.htm

Chemical purification involves the use of iodine or chlorine to kill the nasties in the water. This method is lightweight and relatively inexpensive, but will not neutralize chemical toxins. In addition, you must make sure that water at 25 deg. C (75deg. F) sits for 20-30 minutes with iodine in it for purification to take place. If the water is colder (as it usually is), you will need to let it sit longer - possibly overnight for cold stream water. Warm the water against your body or even on your stove if you want it to be purified faster. Once the appropriate time has elapsed, the "band-aid" taste of iodine can be neutralized with a small amount of ascorbic acid (vitamin C). Used properly, iodine will kill most protozoa and all bacteria and viruses in water. After prolonged use, some people develop thyroid problems, so be aware of this potential side effect.
http://www.fc.net/~tdeagan/water/one.html

Chemical disinfection can be achieved with either iodine or chlorine, with iodine providing greater disinfection in a wider set of circumstances. For disinfection with iodine, use either tincture of iodine or tetraglycine hydroperiodide tablets, such as Globaline®* and Potable-Aqua®*. These disinfectants can be found in sporting goods stores and pharmacies. Read and follow the manufacturer’s instructions. If the water is cloudy, then strain it through a clean cloth and double the number of disinfectant tablets added. If the water is very cold, either warm it or allow increased time for disinfectant to work.
http://www.cdc.gov/travel/foodwatr.htm
 
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