Polihexametileno biguanida como agente antimicrobiano em feridas: evidências sobre disrupção de biofilme e promoção da cicatrização
DOI:
https://doi.org/10.5281/zenodo.22000839Palavras-chave:
Polihexametileno biguanida, PHMB, Feridas, Biofilme, Cicatrização, Carga microbianaResumo
Introdução: As feridas crônicas representam um importante desafio em saúde pública devido à elevada prevalência, impacto na qualidade de vida e custos assistenciais. A formação de biofilmes microbianos compromete o controle da infecção e interfere negativamente no processo de cicatrização. Nesse contexto, a polihexametileno biguanida (PHMB) destaca-se como agente antimicrobiano de amplo espectro, com atividade antibiofilme e perfil favorável de biocompatibilidade. Objetivo: Avaliar as evidências científicas sobre os efeitos da PHMB no tratamento de feridas, com enfoque na redução da carga microbiana, controle de biofilmes e reparação tecidual. Metodologia: Realizou-se uma revisão integrativa da literatura, conduzida conforme as recomendações PRISMA, com buscas nas bases PubMed/MEDLINE, Scopus, Web of Science e PubMed Central. Foram incluídos estudos experimentais, clínicos e revisões publicados entre 2021 e 2026, totalizando 25 estudos. Resultados: A PHMB demonstrou atividade antimicrobiana contra microrganismos frequentemente associados a feridas crônicas, incluindo Staphylococcus aureus e Pseudomonas aeruginosa, promovendo redução da carga microbiana e desorganização de biofilmes. Estudos experimentais também evidenciaram efeitos favoráveis na cicatrização, incluindo aumento da deposição de colágeno, angiogênese, proliferação de fibroblastos e modulação inflamatória. Formulações avançadas, como hidrogéis e nanoformulações, apresentaram potencial para otimizar sua ação terapêutica. Conclusão: A PHMB apresenta potencial relevante no manejo de feridas crônicas, associando atividade antimicrobiana, ação antibiofilme e suporte à reparação tecidual. Entretanto, estudos clínicos com maior padronização metodológica são necessários para estabelecer protocolos terapêuticos mais consistentes.
Referências
ALPARSLAN, L. et al. Smart thermoresponsive Sol-Gel formulation of Polyhexanide for Rapid and painless burn and wound management. Polymers, v. 17, n. 15, p. 2079, 2025.
ASWATHANARAYAN, J. B. et al. Biofilm-Associated Infections in Chronic Wounds and Their Management. Advances in Experimental Medicine and Biology, 2022.
CHEN, Z. et al. Enhanced wound healing and antimicrobial efficacy of PHMB-loaded injectable chitosan/quaternary chitosan/NaHCO3/β-glycerophosphate hydrogels for seawater-infected wounds. International journal of biological macromolecules, v. 310, n. Pt 3, p. 143418, maio 2025.
COLEMAN, L. et al. Non-Antibiotic Compounds Synergistically Kill Chronic Wound-Associated Bacteria and Disrupt Their Biofilms. Pharmaceutics, v. 15, n. 6, p. 1633, 1 jun. 2023.
DAVIS, S. C. et al. Protection with a collagen wound matrix containing polyhexamethylene biguanide supports innate wound healing in biofilm‐infected porcine wounds. Wound Repair and Regeneration, v. 33, n. 2, mar. 2025.
DIAS, F. G. G. et al. Evaluation of the antiseptic and wound healing potential of polyhexamethylene guanidine hydrochloride as well as its toxic effects. European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences, v. 160, p. 105739, jan. 2021.
EDWARDS, G. et al. Identifying infection in chronic wounds in a community setting: A systematic review of diagnostic test accuracy studies. Journal of Advanced Nursing, v. 80, n. 1, 13 ago. 2023.
GOSWAMI, A. G. et al. Biofilm and wound healing: from bench to bedside. European Journal of Medical Research, v. 28, n. 1, 25 abr. 2023.
GRYSON, L. et al. Anti-biofilm Activity of Povidone-Iodine and Polyhexamethylene Biguanide: Evidence from In Vitro Tests. Current microbiology, v. 80, n. 5, 1 abr. 2023.
LAZZARI, G.; CESA, S.; LO PALO, E. Clinical use of 0.1% polyhexanide and propylbetaine on acute and hard-to-heal wounds: a literature review. Journal of Wound Care, v. 33, n. Sup6a, p. cxl–cli, 1 jun. 2024.
LIU, D. et al. Insulin/PHMB-grafted sodium alginate hydrogels improve infected wound healing by antibacterial-prompted macrophage inflammatory regulation. Journal of nanobiotechnology, v. 23, n. 1, p. 328, mar. 2025.
LIU, J. et al. Analysis of risk factors related to chronic non‐healing wound infection and the construction of a clinical prediction model. Experimental Dermatology, v. 33, n. 7, 1 jul. 2024.
NAIR, H. K. et al. Burn injuries in the Asia-Pacific region: Use of polyhexamethylene biguanide and betaine surfactant (phmb-b) for wound bed preparation in children and adults. Journal of wound care, v. 34, n. Sup12c, p. S1-S20, jan. 2025.
NTOW-BOAHENE, W. et al. Fungal cell barriers and organelles are disrupted by polyhexamethylene biguanide (PHMB). Scientific reports, v. 13, n. 1, 16 fev. 2023.
PURCELL, A. et al. Prevalence of wounds and patient characteristics in an australian community setting: A retrospective cohort study. BMJ open, v. 16, n. 5, p. e108091, maio 2026.
QIAN, H. et al. Construction of an Infection-Inflammation Microenvironment-Regulating nano-antimicrobial agent and application in the treatment of Burn wounds complicated with Multidrug-Resistant staphylococcus aureus infection. ACS Applied Materials & Interfaces, 2026. DOI: 10.1021/acsami.6c07159.
RIPPON, M. et al. Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models. Journal of Wound Care, v. 32, n. 6, p. 359–367, 2 jun. 2023.
RIPPON, M. G. et al. Safety and effectiveness of an antiseptic wound cleansing and irrigation solution containing polyhexamethylene biguanide. Journal of wound care, v. 33, n. 5, p. 324–334, 2 maio 2024.
RIPPON, M. G.; ROGERS, A. A.; OUSEY, K. Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review. Journal of Wound Care, v. 32, n. 1, p. 5–20, 2 jan. 2023.
SALISBURY, A.-M. et al. Antibiofilm Efficacy of Polihexanide, Octenidine and Sodium Hypochlorite/Hypochlorous Acid Based Wound Irrigation Solutions against Staphylococcus aureus, Pseudomonas aeruginosa and a Multispecies Biofilm. Advances in Experimental Medicine and Biology, v. 1369, p. 53–67, 2022.
SCHNEIDER, C.; STRATMAN, S.; KIRSNER, R. S. Lower extremity ulcers. The medical clinics of North america, v. 105, n. 4, p. 663–679, 1 jul. 2021.
SEN, C. K. et al. Biofilm Management in Wound Care. Plastic & Reconstructive Surgery, v. 148, n. 2, p. 275e288e, 27 jul. 2021.
SU, J. et al. Development and evaluation of a novel antibacterial wound dressing: A powder preparation based on Cross-Linked pullulan with polyhexamethylene biguanide for Hydrogel-Transition in Advanced wound management and infection control. Polymers, v. 16, n. 10, p. 1352–1352, 10 maio 2024.
VALLEJO, A.; WALLIS, M.; MCMILLAN, D. Use of low-frequency contact ultrasonic debridement with and without polyhexamethylene biguanide in hard-to-heal leg ulcers: an RCT. Journal of Wound Care, v. 31, n. 8, p. 670–681, 2 ago. 2022.
ZHAO, J. et al. Assessment between antiseptic and normal saline for negative pressure wound therapy with instillation and dwell time in diabetic foot infections. Scientific reports, v. 14, n. 1, 19 maio 2024.
