Anti-biofilm Activity of Povidone-Iodine and Polyhexamethylene Biguanide: Evidence from In Vitro Tests

Biofilm in chronic wounds is associated with delayed healing and ineffective local treatment. The purpose of this study was to investigate the in vitro anti-biofilm activity of two commonly used antimicrobials, povidone-iodine (PVP-I) and polyhexamethylene biguanide (PHMB). The rate of anti-biofilm activity of PVP-I, PHMB, and phosphate-buffered saline (negative control) was assessed on monomicrobial biofilms of varying maturity and composition. Antimicrobial efficacy was determined by counting colony-forming units (CFU). Live/dead cell staining and time-lapse confocal microscopy were also performed. Both PVP-I and PHMB demonstrated robust in vitro anti-biofilm activity against all tested biofilms; however, PVP-I had a more rapid action versus PHMB against methicillin-resistant Staphylococcus aureus (MRSA) biofilms, as determined by both CFU counts and microscopy. PVP-I completely eradicated Pseudomonas aeruginosa biofilms of 3- and 5-day maturity (in ≤0.5 h) and 7-day maturity (in ≤3 h), while PHMB only partially depleted cell density, with no complete biofilm eradication even after 24 h. In conclusion, PVP-I had a similar in vitro anti-biofilm activity to PHMB against biofilms of varying microbial compositions and maturity, and in some cases demonstrated more potent and rapid activity versus PHMB. PVP-I may be particularly effective in treating MRSA biofilms. However, further high-quality clinical research on the efficacy of antimicrobials is required.