The Effectiveness of Topical Polyhexamethylene Biguanide (PHMB) Agents for the Treatment of Chronic Wounds: A Systematic Review.

INTRODUCTION: This is the first systematic review to explore the evidence on PHMB and determine how effective this topical agent is for the treatment of chronic wounds.

MATERIALS AND METHODS: PubMed, Ovid MEDLINE, CINAHL, Embase, the Cochrane library, and Scopus were searched for relevant articles published from 1946 to February 3, 2014, with no restrictions on publication status. ProQuest was searched for relevant dissertations, editorials, and conference abstracts. Non-indexed journals were searched and companies that manufacture wound care materials containing PHMB were contacted for unpublished data. Only randomized controlled trials available in English were included. Bias was assessed using the CONSORT document for all included studies. After inclusion and exclusion criteria were determined, four reviewers (ET, SK, SG, RD) independently reviewed each title and abstract of the literature search results to determine whether the paper should be included for this review. When disagreements on study inclusion emerged, reviewers resolved them through discussion.

RESULTS: Of the 1,725 articles identified in the search, 6 met inclusion criteria. Four studies reported wound healing. Two of these studies evaluated changes in wound surface area and the other two evaluated wound bed evolution with variable results. In five studies, participants randomly assigned to PHMB topical agents showed significant improvement in bacterial control compared to control groups. Five studies reported pain reduction from the use of PHMB agents.

DISCUSSION: There were a small number of eligible studies found, but the interventions, outcome measures, and outcome reporting varied greatly, making meta-analysis impossible. PHMB agents were shown to promote healing and reduce pain more effectively than control treatments.

CONCLUSION: The existing evidence shows that topical PHMB may promote healing of chronic stalled wounds, reduce bacterial burden, eliminate methicillin-resistant staphylococcus aureus (MRSA), and alleviate wound-related pain.