Polihexanid: PHMB Antiseptic for Wound Treatment and Preservation

Polihexanid (also polyhexamethylene biguanide, abbreviated PHMB) is a synthetic biocompatible antiseptic with a broad antimicrobial spectrum. It was originally developed as a preservative in contact lens solutions and swimming pool water and has been established since the 2000s as a modern wound antiseptic. Well-known trade names are Lavasept, Prontosan, and Serasept (in combination with octenidine).

Polihexanid has become a standard antiseptic for chronic wounds, burns, contaminated wounds, and in ophthalmology. Compared to older antiseptics such as povidone iodine, hydrogen peroxide, or ethanol, it is characterized by very good tissue tolerance, broad microbial activity, and no cytotoxic effects on wound healing cells.

Mechanism of Action

Polihexanid binds due to its cationic charge to the negatively charged acidic phospholipids and lipopolysaccharides of bacterial cell membranes and fungal cell walls. This leads to a change in membrane permeability and ultimately to lysis of the microorganisms. The positively charged polyhexamethylene biguanide molecules are attracted much more strongly by negative microbial membranes than by predominantly neutral human cells, which explains the selectivity for microbes.

The spectrum of activity includes gram-positive and gram-negative bacteria including MRSA, ESBL producers, Pseudomonas aeruginosa, as well as yeasts, molds, and some viruses. Polihexanid is also effective in biofilms, which is an important property in chronic wounds with established biofilms. Resistance development against polihexanid has not been reported after years of use, making it particularly attractive in terms of antibiotic stewardship.

Pharmacokinetically, systemic resorption after topical application is minimal, with local action in the wound base and wound fluid. Polihexanid is not metabolized and does not accumulate in tissue.

Areas of Application

• Chronic wounds: venous leg ulcers, diabetic foot syndrome, pressure sores, postoperative wound healing disorders
• Acute contaminated wounds: injuries, abrasions, traumatic wounds
• Burns: first and second degree
• Preservation in eye drops, contact lens solutions, and nasal sprays
• Mouth rinses: for periodontitis, oral mucosa inflammation, before dental surgery
• Antiseptic support of wound dressings

Dosage and Application

Wound irrigation: 0.02 or 0.04 percent solution (Lavasept, Prontosan) for wound rinsing, several minutes contact time, then wound dressing. Repeat at each dressing change if necessary.

Wound gel: 0.1 percent polihexanid in viscous gel for application in deep wounds, wound pockets, and in dry wound healing.

Compresses: soaked in 0.02 percent solution, as moist wound dressing.

Duration of use: limited to approximately 2 to 3 weeks for acute wounds, for chronic wounds at regular intervals over longer periods, with ongoing assessment of wound healing.

Without medical consultation: self-application is possible for small superficial wounds, medical supervision is important for larger or chronic wounds.

Side Effects

Frequent: usually very well tolerated. Rarely mild local skin irritation, burning, or pruritus.

Occasional: allergic contact eczema, especially with long-term use.

Rare but important: Polihexanid should not be applied to the middle ear area, the central nervous system, or if penetration into the abdominal cavity, deep cartilage, or hyaline bone occurs, as theoretically cell-damaging effects are possible. Application near salivary glands and deep eye chambers is also not recommended.

Important: although polihexanid has a more favorable safety profile compared to many other antiseptics, application in specific anatomical situations (middle ear, central nervous system) should be avoided. For chronic wounds without improvement over several weeks, medical reevaluation of therapy is advisable.

Interactions

• Anionic surfactants (soaps): can neutralize the cationic activity of polihexanid, rinse wound with water or saline solution before application, not with soap
• Other antiseptics (povidone iodine, hydrogen peroxide, octenidine): should not be used simultaneously, one per application
• Wound dressing materials (hydrogels, collagens): can bind polihexanid and reduce effectiveness

Special Notes

Pregnancy and breastfeeding: topical application is considered safe as systemic resorption is minimal.

Wound healing: Polihexanid has the advantage compared to hydrogen peroxide and povidone iodine of impairing wound healing less. Studies even show improved wound healing compared to saline solution alone in chronic wounds with biofilm.

Duration of use and reevaluation: chronic wounds require an interdisciplinary treatment concept (wound management, treatment of underlying disease, mobilization, nutrition). Polihexanid is an important component, but does not replace diagnosis and treatment of the underlying cause (e.g., venous insufficiency, diabetes, pressure relief).

Allergic reaction: with long-term use over months, allergic contact eczema can develop. If new rashes or redness occur, consider switching to an alternative antiseptic or discontinuing treatment.

You might also be interested in

• Octenidine, another modern wound antiseptic
• Povidone iodine, classic antiseptic
• Chlorhexidine, widely used antiseptic
• Silver sulfadiazine, antibacterial agent for burns
• Clioquinol, older antiseptic

Frequently Asked Questions

Sources

• Gelbe Liste, Polihexanid Active Ingredient Profile
• AWMF S3 Guideline Wound Treatment and Chronic Wounds
• BfArM, Federal Institute for Drugs and Medical Devices
• DGfW German Society for Wound Healing