The place of polyethylene glycol-based ointment containing chloramphenicol in the modern strategy for the treatment of infected wounds and purulent-necrotic lesions

In the structure of acute surgical pathology, complicated infections of the skin and soft tissues retain their leading positions, accounting for up to 30–40% of all initial visits to the surgeon.

Objective: To evaluate the effectiveness (time of transition of wound healing process into reparative phase) and safety of polyethylene glycolbased ointment containing chloramphenicol (Levomekol®) in patients over 18 years of age with complicated infections of the skin and soft tissues.

Material and methods. The article presents outcomes of managing 30 patients with complicated infections of the skin and soft tissues, having various etiology and location. It was a non-interventional prospective clinical trial conducted at the department of wounds and wound infections of A.V. Vishnevsky National Medical Research Center of Surgery subordinate to the Ministry of Health of Russia (2023), as a part of joint research with Russian Peoples' Friendship University, subordinate to the Ministry of Education and Science of Russia. The trial was ordered by the pharmaceutical company Nizhpharm JSC (subject code: No. 032103-3-000).

Research results. By the study design, patients with diagnosed complicated infections of the skin and soft tissues of various etiology and location when purulent foci required surgical intervention were enrolled in the trial. Topical treatment at the postoperative period included daily wound dressings with polyethylene glycol-based ointment containing chloramphenicol (Levomekol®). By day 10 ± 1 of observation, edema and hyperemia disappeared in 25 (83.30 %) patients. Purulent discharge was absent in 27 (90.00 %) patients on day 3rd after surgery; and on day 7, no purulent discharge was registered in all 30 (100.00 %) patients. Granulation tissue formation was noted already on day 3 at the postoperative period, and by day 10 only 4 (13.33 %) patients had no granulation in their wounds. Microbial wound contamination also had a positive dynamics. By day 3 after surgical treatment of the purulent focus, in more than 90.00 % of patients there were no growth of pathogenic flora (except S. aureus). 20 (66.67 %) patients had no any S. aureus growth (i. e. culture test results were marked as “no growth”). By day 5, only 6 (20.00 %) patients had S. aureus growth equal to more than 105 CFU/g of tissue. In the rest of patients, there was either no growth or there was quantitative microbial contamination below 105 CFU/g tissue. By day 7–10 after surgical treatment, a marked quantitative growth was observed only in 4 (13.33 %) patients.

By day 10 ± 1 inflammatory, inflammatory-regenerative and regenerative types of cytograms prevailed, while purulent-inflammatory and destructive-inflammatory processes were seen only in wounds of 3 (10.0 %) patients. The identified dynamics, manifested by the objective criteria, indicated that the wound process had transformed into the regeneration phase.

Initially, 22 patients had no pain (73.3 %, VAS 0). In other 8 patients, pain was from 3 to 8 points. By day 7 in 4 (50.0 %) patients pain decreased by 50.0 %. No adverse events requiring discontinuation or changes of the topical treatment were registered.

Conclusion. A technique of active surgical treatment of wounds and purulent-necrotic lesions, developed at A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Health of Russia (former Institute of Surgery named after. A. V. Vishnevsky), promotes eradication of purulent process and its transition into the regeneration stage. It also creates conditions for plastic surgery aimed to accelerate wound healing with primary intention even under surgical infection. An important component of the technique of active wound surgical treatment is topical therapy which is currently rapidly developing, especially being added with negative pressure, ultrasonic cavitation, laser technologies and others. At the same time, the classical bandaging in patients with purulent wounds has not lost its relevance. It is worth underlining that ointments based on polyethylene glycol, in particular, time-tested ointment Levomekol®, retain their high activity and effectiveness both for relieving infections and in preparing wounds for subsequent plastic surgery. With its continued effectiveness, the ointment still has a high safety profile due to which we keep on recommending it for treating complicated infections of the skin and soft tissues.

In the structure of acute surgical pathology, complicated infections of the skin and soft tissues retain their leading positions, accounting for up to 30–40% of all initial visits to the surgeon.

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