Difference between revisions of "Chlorhexidine"

Latest revision as of 10:07, 20 September 2010

Chlorhexidine is a chemical antiseptic.^[1] It is effective on both Gram-positive and Gram-negative microbes, although it is less effective with some Gram-negative microbes.^[2] It has both bactericidal as well as bacteriostatic mechanisms of action, the mechanism of action being membrane disruption not ATPase inactivation as previously thought.^[3] It is also useful against fungi and enveloped viruses, though this has not been extensively investigated. Products containing chlorhexidine in high concentrations must be kept away from eyes and the ears, due to the risk of damage to those organs. However, chlorhexidine is safely used in very low concentrations in some contact lens solutions.

Availability

Chlorhexidine is present in oral rinses and skin cleansers, and in small quantities it is used as a preservative.

It is sometimes marketed under the brand names Peridex, Periochip, Perichlor or Periogard Oral Rinse. In the UK it is mainly marketed under the brand name Corsodyl (or Chlorohex); in Italy as Curasept (Curaden Healthcare srl); in Germany as Chlorhexamed; in Australia and New Zealand as Savacol; in India as Suthol (G. D. Pharmaceuticals), Sterimax (Bioshields), Clohex or Dejavu-MW (QUADRA); in Venezuela as Perioxidina or Peridont, and in some Central American countries as Clorexil.

As a skin cleanser, it is marketed under brand names such as Hibiclens, Savinox plus (Bioshields), Surgiprep-CHX (Bioshields), Hibiscrub, or Dexidin mainly as a surgical scrub, and is also available as a wound wash. It is also used in some acne skin washes. It is also used as part of a treatment for athlete's foot. In some countries, it is available by prescription only.

Dental

It is often used as an active ingredient in mouthwash designed to reduce dental plaque and oral bacteria. Chlorhexidine can thus be used to improve bad breath.^[4] It has been shown to have an immediate bactericidal action and a prolonged bacteriostatic action due to adsorption onto the pellicle-coated enamel surface.^[5]

Chlorhexidine-based products are commonly used to combat or prevent gum diseases such as gingivitis. According to Colgate,^[6] chlorhexidine gluconate has not been proven to reduce subgingival calculus and in some studies actually increased deposits. When combined with xylitol, a synergistic effect has been observed to enhance efficacy.^[7]

Chlorhexidine's role in preventing tooth decay (dental caries) is controversial:

Based on the available reviews, chlorhexidine rinses have not been highly effective in preventing caries, or at least the clinical data are not convincing. Due to the current lack of long-term clinical evidence for caries prevention and reported side effects, chlorhexidine rinses should not be recommended for caries prevention. Due to the inconclusive literature and sparse clinical data on gels and varnishes, their use for caries prevention should also be studied further to develop evidence-based recommendations for their clinical role in caries prevention. Since dental caries is a disease with a multifactoral etiology, it is currently more appropriate to use other established, evidence-based prevention methods, such as fluoride applications, diet modifications and good oral hygiene practices. Recent findings also indicate that the effect of an antimicrobial agent for reducing the levels of mutans streptococci or plaque reduction may not always correlate with eventual caries reduction.^[8]

Continued use of products containing chlorhexidine for long periods can cause stains on teeth, especially on silicate and resin restorations; prolonged use can also alter taste sensation - this latter symptom can be reversed by ceasing use of chlorhexidine.^[9] A version which stains the teeth less has been developed.^[10] Chlorhexidine is neutralized by common toothpaste additives such as sodium lauryl sulfate (SLS) and sodium monofluorophosphate (MFP). Although data are limited, to maximize effectiveness it may be best to keep a 30-minute to 2-hour interval between brushing and using the mouthwash.^[11]

Topical

Chlorhexidine is also used in nondental applications, most notably under the brand names Oronine, Avagard, Hibiclens,Savinox plus (Bioshields), Hibiscrub, ChloraPrep, ChloraScrub, BIOPATCH, SOLU-I.V. and Exidine. It is also a component of the household antiseptic Savinox plus (Bioshields) and Savlon. It is used for general skin cleansing, a surgical scrub, and a pre-operative skin preparation. Due to other chemicals listed as inactive ingredients, the cleanser solution is not suitable for use as mouthwash. It is often used as a rubbing agent prior to the use of hypodermic or intravenous needles in place of iodine. Chlorhexidine is contraindicated for use near the meninges, in body cavities, and near the eyes and ears. At the 2% concentration, it can cause serious and permanent injury with prolonged contact with the eye or if instilled carefully and going through the nose through a perforated eardrum. Nevertheless, a topical solution of 0.02% chlorhexidine is recommended by the US Centers for Disease Control and Prevention (CDC) as treatment for keratitis caused by Acanthamoeba. As a scrub, chlorhexidine is not recommended on persons under two months of age.

Use in animals

For use in animals, it is used as a topical disinfectant of wounds. It is more effective in killing bacteria than both povidone-iodine and saline, and has residual effects up to 6 hours. Some common brand names are ChlorhexiDerm, ResiChlor, Savinox plus (Bioshields), Germi-STAT Antimicrobial Skin Cleanser, Nolvasan Skin and Wound Cleaner, and Nolvasan Ointment. It is also more beneficial to wound healing than using saline solutions alone.^[12] Note, however, that problems^[13] including deafness^[14] have been associated with the use of chlorhexidine products in cats. It is commonly used to manage skin infections in dogs.

Deactivation

Chlorhexidine is deactivated by anionic compounds, including the anionic surfactants commonly used as detergents in toothpastes and mouthwashes. For this reason, chlorhexidine mouth rinses should be used at least 30 minutes after other dental products.^[15] For best effectiveness, food, drink, smoking, and mouth rinses should be avoided for at least one hour after use.

Although chlorhexidine is effective in the presence of blood, soap, and pus, its activity is reduced.^[16]

References

External links

• Drugs.com states that this information comes directly from the FDA.

da:Klorhexidin de:Chlorhexidin el:Χλωρεξιδίνη es:Clorhexidina fr:Chlorhexidine it:Clorexidina hu:Klórhexidin nl:Chloorhexidinedigluconaat no:Klorheksidin ja:クロルヘキシジン pl:Chlorheksydyna pt:Gluconato de clorexidina ro:Clorhexidină ru:Хлоргексидин sv:Klorhexidin

1. ↑ "Chlorhexidine Official FDA information, side effects and uses". Drug information Online. Drugs.com. Revised 11/2006. Retrieved 2007-10-08.  Check date values in: |date= (help) Drugs.com states that this information comes directly from the FDA
2. ↑ "THE MOST COMMON TOPICAL ANTIMICROBIALS". Care of the umbilical cord. World Health Organization. 1998. Retrieved 2007-10-08. 
3. ↑ Kuyyakanond T, Quesnel LB. (1992-12-15). "The mechanism of action of chlorhexidine". FEMS Microbiol Lett. 79 (1-3): 211–215. doi:10.1111/j.1574-6968.1991.tb04531.x. PMID 1335944.  |access-date= requires |url= (help)
4. ↑ http://www.freshbreath.ca/fbcpubs.html
5. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
6. ↑ "Colgate PerioGard chlorhexidine gluconate oral rinse 0.12% (Rx)". 
7. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
8. ↑ Autio-Gold J (2008). "The role of chlorhexidine in caries prevention". Oper Dent. 33 (6): 710–6. doi:10.2341/08-3. PMID 19051866. 
9. ↑ Effects of chlorhexidine on human taste perception. [Arch Oral Biol. 1995] - PubMed Result
10. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
11. ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
12. ↑ Sanchez IR, Swaim SF, Nusbaum KE, Hale AS, Henderson RA, McGuire JA (1988). "Effects of chlorhexidine diacetate and povidone-iodine on wound healing in dogs". Vet Surg. 17 (6): 291–5. doi:10.1111/j.1532-950X.1988.tb01019.x. PMID 3232321. CS1 maint: Multiple names: authors list (link)
13. ↑ http://www.addl.purdue.edu/newsletters/1996/winter/psrd.shtml
14. ↑ http://www.petplace.com/cats/deafness-in-cats/page2.aspx
15. ↑ Denton W , Chlorhexidine In: Sterilisation and Preservation 5th Edition, Block SS, eds. Lippincott Williams & Williams, Philadelphia, 2001; 321-36.
16. ↑ World Health Organization, Care of the Umbilical Cord/annex, http://www.who.int/reproductive-health/publications/MSM_98_4/MSM_98_4_annex.en.html