Antiseptics chlorhexidine

Stalder, J.F. et al., Comparative effects of two topical antiseptics (chlorhexidine vs. KMn04) on bacterial skin flora in atopic dermatitis. Acta Derm. Venereol. (Stockh.) 176(Suppl.), 132-134, 1992. 

A newer development in controlled local delivery, one that utilizes the antiseptic chlorhexidine as the antimicrobial agent, has been introduced in a number of countries and was recently cleared by the FDA for use in the United States. This delivery system, PerioChip (manufactured by Perio Products Ltd., Jerusalem, Israel distributed by Dexell Pharmaceuticals, Edison, NJ), was developed in Israel and has been tested in the United States as well as in Europe. 

Topical antiseptics and germicides are primarily used to reduce the number of bacteria on skin surfaces. Some of these drag s, such as chlorhexidine gluconate, may be used as a surgical scrub, as a preoperative skin cleanser, for washing the hands before and after caring for patients, and in the home to cleanse the skin. Others may be applied to minor cuts and abrasions to prevent infection. Some of these drag s may also be used on mucous membranes. 

Other Agents. Allergic reactions to chlorhexidine have been observed after insertion of central catheters impregnated with this antiseptic, or after intraurethral use or topical application [26]. Only rare cases of anaphylaxis following topical use of povidone-iodine have been reported. 

As is apparent from the above information, there is no ideal disinfectant, antiseptic or preservative. All chemical agents have their limitations either in terms of their antimicrobial activity, resistance to organic matter, stability, incompatibility, irritancy, toxicity or corrosivity. To overcome the limitations of an individual agent, formulations consisting of combinations of agents are available. For example, ethanol has been combined with chlorhexidine and iodine to produce more active preparations. The combination of chlorhexidine and cetrimide is also considered to improve activity. QACs and phenols have been combined with glutaraldehyde so that the same effect can be achieved with lower, less irritant concentrations of glutaraldehyde. Some... 

Chlorhexidine-cetrimide antiseptic solution Pseudemenas cepacia... 

Chlorhexidine is an antiseptic mouthv/ash that inhibits plaque formation on the teeth. 

Triclosan cannot only be applied as an emulsion, but it also has demonstrated antibacterial and antiinflammatory efficacy in eczema therapy when used as an antiseptic wash.28,30 Likewise, 10% povidone-iodine solution as a disinfectant showed excellent antibacterial activity together with improvement of clinical severity.79 As a 1% solution, chlorhexidine digluconate has shown superior effectiveness to triclosan in vitro, but may be only suitable for therapeutic use in intertriginous areas or as part of wet wrap dressings in the treatment of AD when used as an alcoholic solution.26,80... 

The need of skin disinfectants before injection is controversial.110 It is generally thought that the use of antiseptics may be ineffective and unnecessary.111112 Aseptic conditions are required for the use of catheters to minimize the infection. Povidone iodine and chlorhexidine are commonly used for the catheters. 

Plasmid-mediated resistance to QACs and chlorhexidine in S. aureus has been cloned in E. coli [302] but the level of resistance is low and the mechanism not fully elucidated. The efflux-mediated antiseptic resistance gene qacA from S. aureus has a common ancestry with tetracycline- and sugar-transported proteins [227-229]. 

When prolonged treatment is required, topical antiseptics (e.g. chlorhexidine) are preferred and bacterial resistance is less of a problem. 

Eighteen cases of an ichthyosiform contact dermatitis caused by antiseptic solutions containing 3% cetrimide and 0.3% chlorhexidine have been reported (5,6). Biopsies showed hyperkeratosis with striking vesicula-tion of lamellar bodies in the granular cells and upper spinous cells, premature secretion of lamellar bodies, and abundant remnants of lamellar bodies and retention of desmosomes between corneocytes. Cetrimide, and not chlorhexidine, was said to be the cause of the dermatitis. 

Five healthy newborn breast-fed babies were accidentally fed a dilute antiseptic solution containing chlorhexidine 0.05% with cetrimide 1% instead of sterile water (9). They developed caustic burns of the lips, mouth, and... 

Following disinfection of a drain insertion site with chlorhexidine digluconate 2% solution, a 43-year-old man had severe anaphylaxis, manifest as dyspnea, shock, and ST segment elevation (46). In the past he had had two episodes of contact dermatitis with chlorhexidine antiseptics. 

A meta-analysis of the clinical and economic effects of chlorhexidine and silver sulfadiazine antiseptic-impregnated catheters has been undertaken (60). The costs of hypersensitivity reactions were considered as part of the analysis, and the use of catheters impregnated with antiseptics resulted in reduced costs. The analysis used the higher estimated incidence of hypersensitivity reactions occurring in Japan, where the use of chlorhexidine-impregnated catheters is still banned (61). 

Mncklow ES. Accidental feeding of a dilnte antiseptic solution (chlorhexidine 0.05% with cetrimide 1%) to five babies. Hnm Toxicol 1988 7(6) 567-9. 

For skin disinfection, chlorhexidine has been formulated as a 0.5% w/v solution in 70% v/v ethanol and, in conjunction with detergents, as a 4% w/v surgical scrub. Chlorhexidine salts may also be used in topical antiseptic creams, mouthwashes, dental gels, and in urology for catheter sterilization and bladder irrigation. 

Roberts WR, Addy M. Gomparlson of the in vivo and in vitro antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, cetylpyridinium chloride and hexetidine - relevance to mode of action. J Clin Periodontol 1981 8(4) 295-310. 

Preservatives and disinfectants. Many preservatives and disinfectants can be metabolized by a wide variety of Gram-negative bacteria, although most commonly at concentrations below their effective use levels. Growth of pseudomonads in stock solutions of quaternary ammonium antiseptics and chlorhexidine has resulted in infection of patients. Pseudomonas spp. have metabolized 4-hydroxy-benzoate ester preservatives contained in eye-drops and caused serious eye infections, and have also metabolized the preservatives in oral suspensions and solutions. In selecting suitable preservatives for formulation, a detailed knowledge of the properties of such agents, their susceptibility to contamination and limitations clearly provides invaluable information. 

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