Effectiveness of a Topical Formulation Containing Metronidazole for Wound Odor and Exudate Control

Cathy Kalinski, RN, BSN, CWCN, COCN; Mary Schnepf, RNC, MPH, ET; Debbie Laboy, RPh; Lucy Hernandez, MS, APRN, BC; Jeanne Nusbaum, RN; Brian McGrinder, RPh; Christopher Comfort, MD; Oscar M. Alvarez, PhD

Disclosures

Wounds. 2005;17(4):84-90. 

In This Article

Results

Treatment with metronidazole 0.75% gel was easy and convenient. The application of this topical medication was not associated with any pain or discomfort. The effect of metronidazole 0.75% gel on wound odor is presented in Figures 1 and 2. Figure 1 summarizes the odor scores as determined by the investigator, and Figure 2 presents the scores determined by the patients. There was a statistically significant ( p <0.05) decrease in wound odor 24 hours after just 1 (initial) application in both investigator and patient data sets. Statistical significance ( p <0.05) was also noted on Days 7 and 14 after the initiation of therapy. Metronidazole 0.75% gel was effective throughout the entire 2-week treatment period. For the most part, there was a close correlation between the investigator and patient odor score. With 2 exceptions (Day 6 and Day 8), the score variation between patient and investigator was <30% (Figure 3). The response to topical metronidazole on wound odor was dramatic with a 100% response rate (10 patients reported complete odor elimination, and 6 reported marked improvement [Figure 4]). Wounds treated with topical metronidazole exhibited less drainage. The decrease in the amount of wound exudate was noticeable after just 2 applications (48 hours) and persisted throughout the study period. The effect of topical metronidazole gel on the amount of wound exudate is presented in Figure 5. Although the differences in wound drainage before and after treatment were clinically evident, they were not statistically significant ( p =0.096).

Effect of metronidazole 0.75% gel on wound odor as determined by investigator. Results represent mean odor scores. A score of 0=no odor, 1-4=minimally offensive, 5-8=moderately offensive, and 9-10=extremely offensive. *Indicates a statistically significant difference between the means when compared to baseline, Day 0 (prior to treatment) at p<0.05.

Effect of metronidazole 0.75% gel on wound odor as determined by patients. Results represent mean odor scores. A score of 0=no odor, 1-4=minimally offensive, 5-8=moderately offensive, and 9-10=extremely offensive. *Indicates a statistically significant difference between the means when compared to baseline, Day 0 (prior to treatment) at p <0.05.

Effect of metronidazole 0.75% gel on wound odor: summary of investigator and patient scores. Results represent mean odor scores. A score of 0=no odor, 1-4=minimally offensive, 5-8=moderately offensive, and 9-10=extremely offensive.

Twenty-four hour response to metronidazole 0.75% gel.

Amount of wound exudate before and after treatment with metronidazole 0.75% gel. *Wound exudate assessment performed by investigator (3=heavy, 2=moderate, 1=scant).

The costs associated with metronidazole 0.75% gel compounded by the authors' pharmacists and the cost to the hospital of the equivalent commercial formulation is shown in Table 2 . The cost for the compounded formulation was $1.68 for a 2oz jar (or $0.028/g) and the cost of MetroGelTM (Galderma, Fort Worth, Tex) was $43.50 for 45g (or $0.96/g). A total of 8,640g (144 2oz jars) were used throughout the study (16 patients for 2 weeks) totaling $241.92. Based on the 8,640g used, it would have cost $8,294.40 to use the commercially available formulation. This constitutes a savings of $7,882.74.

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