Triclosan and silver compound containing medical devices

Details Triclosan and silver compound containing medical devices Triclosan and silver compound containing medical devices

1999-03-31

2001-05-01

Kennedy, Sharon (Department: 3763)

Surgery

Means for introducing or removing material from body for...

Treating material introduced into or removed from body...

C424S422000, C623S001210, C428S035700

Reexamination Certificate

active

06224579

ABSTRACT:

1.0 INTRODUCTION
The present invention relates to medical devices comprising synergistic combinations of triclosan and silver containing compounds.
2.0 BACKGROUND OF THE INVENTION
Whenever a medical device comes in contact with a patient, a risk of infection is created. Thus, a contaminated examination glove, tongue depressor, or stethoscope could transmit infection. The risk of infection dramatically increases for invasive medical devices, such as intravenous catheters, arterial grafts, intrathecal or intracerebral shunts and prosthetic devices, which not only are, themselves, in intimate contact with body tissues and fluids, but also create a portal of entry for pathogens.
A number of methods for reducing the risk of infection have been developed which incorporate anti-infective agents into medical devices, none of which have been clinically proven to be completely satisfactory. Such devices desirably provide effective levels of anti-infective agent during the entire period that the device is being used. This sustained release may be problematic to achieve, in that a mechanism for dispersing anti-infective agent over a prolonged period of time may be required, and the incorporation of sufficient amounts of anti-infective agent may adversely affect the surface characteristics of the device. The difficulties encountered in providing effective antimicrobial protection increase with the development of drug-resistant pathogens.
One potential solution to these problems is the use of a synergistic combination of anti-infective agents that requires relatively low concentrations of individual anti-infective agents which may have differing patterns of bioavailability.
Two well-known anti-infective agents are chlorhexidine and triclosan. The following patents and patent application relate to the use of chliorhexidine and/or triclosan in medical devices.
U.S. Pat. No. 4,723,950 by Lee relates to a microbicidal tube which may be incorporated into the outlet tube of a urine drainage bag. The microbicidal tube is manufactured from polymeric materials capable of absorbing and releasing anti-microbial substances in a controllable sustained time release mechanism, activated upon contact with droplets of urine, thereby preventing the retrograde migration of infectious organisms into the drainage bag. The microbicidal tube may be produced by one of three processes: (1) a porous material, such as polypropylene, is impregnated with at least one microbicidal agent, and then coated with a hydrophilic polymer which swells upon contact with urine, causing the leaching out of the microbicidal agent; (2) a porous material, such as high density polyethylene, is impregnated with a hydrophilic polymer and at least one microbicidal agent; and (3) a polymer, such as silicone, is compounded and co-extruded with at least one microbicidal agent, and then coated with a hydrophilic polymer. A broad range of microbicidal agents are disclosed, including chlorhexidine and triclosan, and combinations thereof. The purpose of Lee's device is to allow the leaching out of microbicidal agents into urine contained in the drainage bag; similar leaching of microbicidal agents into the bloodstream of a patient may be undesirable.
U.S. Pat. No. 5,091,442 by Milner relates to tubular articles, such as condoms and catheters, which are rendered antimicrobially effective by the incorporation of a non-ionic sparingly soluble antimicrobial agent, such as triclosan. The tubular articles are made of materials which include natural rubber, polyvinyl chloride and polyurethane. Antimicrobial agent may be distributed throughout the article, or in a coating thereon. A condom prepared from natural rubber latex containing 1% by weight of triclosan, then dipped in an aqueous solution of chlorhexidine, is disclosed. U.S. Pat. Nos. 5,180,605 and 5,261,421, both by Milner, relate to similar technology applied to gloves.
U.S. Pat. Nos. 5,033,488 and 5,209,251, both by Curtis et al., relate to dental floss prepared from expanded polytetrafluoroethylene (PTFE) and coated with microcrystalline wax. Antimicrobial agents such as chlorhexidine or triclosan may be incorporated into the coated floss.
U.S. Pat. No. 5,200,194 by Edgren et al. relates to an oral osmotic device comprising a thin semipermeable membrane wall surrounding a compartment housing a “beneficial agent” (that is at least somewhat soluble in saliva) and a fibrous support material composed of hydrophilic water-insoluble fibers. The patent lists a wide variety of “beneficial agents” which may be incorporated into the oral osmotic device, including chlorhexidine and triclosan.
U.S. Pat. No. 5,019,096 by Fox, Jr., et al. relates to infection-resistant medical devices comprising a synergistic combination of a silver compound (such as silver sulfadiazine) and chlorhexidine.
International Patent Application No. PCT/GB92/01481, Publication No. WO 93/02717, relates to an adhesive product comprising residues of a copolymerisable emulsifier comprising a medicament, which may be povidone iodine, triclosan, or chlorhexidine.
International Patent Application No. PCT/US96/20932, Publication No. WO 97/25085, relates to polymeric medical articles comprising synergistic combinations of chlorhexidine and triclosan which utilize relatively low levels of these agents.
In contrast to the present invention, none of the above-cited references teach medical articles comprising synergistic combinations of triclosan and silver compounds which utilize relatively low levels of these agents and provide effective levels of antimicrobial activity, even in the absence of chlorhexidine.
3.0 SUMMARY OF THE INVENTION
The present invention relates to polymeric medical articles comprising combinations of triclosan and/or other chlorinated phenols and silver-containing compounds. It is based, at least in part, on the discovery that these agents act synergistically, thereby permitting the use of relatively low levels of both agents. While it had been previously found that triclosan can be particularly useful when used in conjunction with chlorhexidine, it has been further discovered that medical articles having suitable antimicrobial properties may be prepared, according to the present invention, which contain triclosan and a silver compound without chlorhexidine. Such medical articles offer the advantage of preventing or inhibiting infection while avoiding undesirable adverse reactions to chlorhexidine by individuals that may have a sensitivity to chlorhexidine, such as a chlorhexidine allergy.
The present invention is also based, at least in part, on the discovery that the surface of medical articles, especially catheters, impregnated with triclosan and silver compounds generally were found to be smoother and shinier in comparison with catheters impregnated with triclosan and chlorhexidine. Even when the triclosan-silver compound impregnated catheters exhibited commensurate or smaller zones of inhibition compared to triclosan-chlorhexidine catheters, there was little or no bacterial adherence observed on the former when exposed to bacterial culture. Microbial adherence on the surfaces of medical devices are the result of a deposition of fibrinogen and fibronectin on the surface which forms a host biofilm. Because bacteria tend to adhere to this biofilm, glycocalyx forms which serves as a bacterial reservoir causing blood stream infections. Without being bound by any particular theory, it is believed that medical articles of the invention, by virtue of their smooth surfaces, may be less physically irritating than prior art devices, may be less likely to provoke fibrinogen and/or fibronectin deposition, and therefore may avoid bacterial colonization.
4.0 DETAILED DESCRIPTION OF THE INVENTION
The present invention relates to medical articles comprising combinations of triclosan and/or another chlorinated phenol and one or more silver-containing compound (hereafter, “silver compound”).
While not being bound or limited by any particular theory, it is believed that the combination of triclosan and a silver compound forms

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