Chlorhexidine gluconate
Overview
Chlorhexidine is a chemical antiseptic
Antiseptic
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...

. It is effective on both Gram-positive
Gram-positive
Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain and appearing red or pink...

 and Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...

 bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

, although it is less effective with some Gram-negative bacteria. It has both bactericidal and bacteriostatic mechanisms of action, the mechanism of action being membrane disruption, not ATPase
ATPase
ATPases are a class of enzymes that catalyze the decomposition of adenosine triphosphate into adenosine diphosphate and a free phosphate ion. This dephosphorylation reaction releases energy, which the enzyme harnesses to drive other chemical reactions that would not otherwise occur...

 inactivation as previously thought. It is also useful against fungi and enveloped viruses, though this has not been extensively investigated.
Encyclopedia
Chlorhexidine is a chemical antiseptic
Antiseptic
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...

. It is effective on both Gram-positive
Gram-positive
Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. This is in contrast to Gram-negative bacteria, which cannot retain the crystal violet stain, instead taking up the counterstain and appearing red or pink...

 and Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...

 bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

, although it is less effective with some Gram-negative bacteria. It has both bactericidal and bacteriostatic mechanisms of action, the mechanism of action being membrane disruption, not ATPase
ATPase
ATPases are a class of enzymes that catalyze the decomposition of adenosine triphosphate into adenosine diphosphate and a free phosphate ion. This dephosphorylation reaction releases energy, which the enzyme harnesses to drive other chemical reactions that would not otherwise occur...

 inactivation as previously thought. It is also useful against fungi and enveloped viruses, though this has not been extensively investigated. Chlorhexidine is harmful in high concentrations, but is used safely in low concentrations in many products, such as mouthwash and contact lens
Contact lens
A contact lens, or simply contact, is a lens placed on the eye. They are considered medical devices and can be worn to correct vision, for cosmetic or therapeutic reasons. In 2004, it was estimated that 125 million people use contact lenses worldwide, including 28 to 38 million in the United...

 solutions.

Availability

Chlorhexidine is present in oral rinses and skin cleansers, and in small quantities it is used as a preservative
Preservative
A preservative is a naturally occurring or synthetically produced substance that is added to products such as foods, pharmaceuticals, paints, biological samples, wood, etc. to prevent decomposition by microbial growth or by undesirable chemical changes....

.

It is sometimes marketed under the brand names Foam Safe, Hexicleans, Peridex, Periochip, Perichlor or Periogard Oral Rinse. In the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 it is mainly marketed under the brand name Corsodyl (or Chlorohex); in Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

 as Curasept (Curaden Healthcare srl); in Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

 as Chlorhexamed; in Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

 and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

 as Savacol; in Greece
Greece
Greece , officially the Hellenic Republic , and historically Hellas or the Republic of Greece in English, is a country in southeastern Europe....

 as Chrolhexil (Intermed S.A.); in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

 as Suthol (G. D. Pharmaceuticals), Sterimax (Bioshields), Clohex or Dejavu-MW (QUADRA); in Venezuela
Venezuela
Venezuela , officially called the Bolivarian Republic of Venezuela , is a tropical country on the northern coast of South America. It borders Colombia to the west, Guyana to the east, and Brazil to the south...

 as Perioxidina or Peridont, in Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

 as Oronine 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, Hexigard 4 as surgical hand wash, Hexigard HR as hand rub (Mil Laboratories Pvt Ltd) 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
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....

 only.

Dental

It is often used as an active ingredient in mouthwash
Mouthwash
Mouthwash or mouth rinse is a product used to enhance oral hygiene. Some manufacturers of mouthwash claim that antiseptic and anti-plaque mouth rinse kill the bacterial plaque causing cavities, gingivitis, and bad breath. Anti-cavity mouth rinse uses fluoride to protect against tooth decay...

 designed to reduce dental plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

 and oral bacteria. It has been shown to have an immediate bactericidal action and a prolonged bacteriostatic action due to adsorption
Adsorption
Adsorption is the adhesion of atoms, ions, biomolecules or molecules of gas, liquid, or dissolved solids to a surface. This process creates a film of the adsorbate on the surface of the adsorbent. It differs from absorption, in which a fluid permeates or is dissolved by a liquid or solid...

 onto the pellicle-coated enamel
Tooth enamel
Tooth enamel, along with dentin, cementum, and dental pulp is one of the four major tissues that make up the tooth in vertebrates. It is the hardest and most highly mineralized substance in the human body. Tooth enamel is also found in the dermal denticles of sharks...

 surface. If it is not deactivated, chlorhexidine lasts longer in the mouth than other mouthwashes and this is partly why it is preferred over other treatments for gingivitis.

Chlorhexidine-based products are commonly used to combat or prevent gum diseases such as gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

. According to Colgate
Colgate
- Places :*Colgate, West Sussex, UK*Colgate, North Dakota, USA*Colgate, Wisconsin, USA*Colgate, Saskatchewan, India- People :*Pat Colgate, the artistic director of the Placer Theatre Ballet dance company...

, chlorhexidine gluconate has not been proven to reduce subgingival calculus
Calculus (dental)
In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...

 and in some studies actually increased deposits. When combined with xylitol
Xylitol
Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch...

, a synergistic effect has been observed to enhance efficacy.

Chlorhexidine's role in preventing tooth decay (dental caries) is controversial. In a 2008 article for Operative Dentistry, dentistry researcher Jaana Autio-Gold has written:
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
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...

 is a disease with a multifactoral etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....

, it is currently more appropriate to use other established, evidence-based prevention methods, such as fluoride
Fluoride
Fluoride is the anion F−, the reduced form of fluorine when as an ion and when bonded to another element. Both organofluorine compounds and inorganic fluorine containing compounds are called fluorides. Fluoride, like other halides, is a monovalent ion . Its compounds often have properties that are...

 applications, diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

 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.


There are oral pathologic conditions in which the maintenance of oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...

 with the twice-daily use with 0.12% chlorhexidine-gluconate solution is required for healing
Healing
Physiological healing is the restoration of damaged living tissue, organs and biological system to normal function. It is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area....

 and regeneration
Regeneration
-In biology:* Regeneration , the ability to recreate lost or damaged tissues, organs and limbs* Bush regeneration, an ecological technique practiced in Australia-In music:* Regeneration , a 1977 album by Roy Orbison...

 of the oral
Oral
The word oral may refer to:As an adjective:* the mouth, the first portion of the alimentary canal that receives food and saliva* speech communication as opposed to writing* oral administration of medicines...

 tissues. These conditions included gingivitis
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...

, periodontitis, dental trauma
Dental trauma
Dental trauma refers to trauma to the face, mouth, and especially the teeth lips and periodontium. The study of dental trauma is called dental traumatology.- Types :* Tooth fractures**Enamel infraction**Enamel fracture**Enamel-dentine fracture...

s (such as subluxation
Dental subluxation
Dental subluxation is an traumatic injury in which the tooth has increased mobility but hasnot been displaced from its original site in the jawbone.- Prevalence :This is a quite common condition and one of the commonest dental traumatic disorders...

), oral cysts
Odontogenic cyst
Odontogenic cyst is a closed sac, having a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That...

, and after wisdom tooth
Wisdom tooth
A wisdom tooth, in humans, is any of the usually four third molars. Wisdom teeth usually appear between the ages of 17 and 25. Most adults have four wisdom teeth, but it is possible to have fewer , or more, in which case they are called supernumerary teeth...

 extraction. 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. A version which stains the teeth less has been developed. Chlorhexidine is neutralized by common toothpaste additives such as sodium lauryl sulfate (SLS) and sodium monofluorophosphate
Sodium monofluorophosphate
Sodium monofluorophosphate, commonly abbreviated MFP, is the inorganic compound with the formula Na2PO3F. Typical for a salt, MFP is odourless, colourless, and water-soluble. This salt is an ingredient in some toothpastes.-Uses of MFP:...

 (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.

Topical

Chlorhexidine is also used in nondental applications, most notably under the brand names Foam Safe, Hexicleans,Tipset sachets (sterets), 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), Termilon(Mil Laboratories Pvt Ltd) and Savlon. It is used for general skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 cleansing, a surgical scrub, and a pre-operative skin preparation. Due to other chemicals listed as inactive ingredients, most cleansers are not recommended for use as mouthwash though some originally were used prior to the development of oral alternatives. It is often used as a rubbing agent prior to the use of hypodermic or intravenous needles in place of iodine
Iodine
Iodine is a chemical element with the symbol I and atomic number 53. The name is pronounced , , or . The name is from the , meaning violet or purple, due to the color of elemental iodine vapor....

. Chlorhexidine is contraindicated for use near the meninges
Meninges
The meninges is the system of membranes which envelopes the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.-Dura...

, 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
Topical
In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...

 solution of 0.02% chlorhexidine is recommended by the US Centers for Disease Control and Prevention (CDC) as treatment for keratitis
Keratitis
Keratitis is a condition in which the eye's cornea, the front part of the eye, becomes inflamed. The condition is often marked by moderate to intense pain and usually involves impaired eyesight.-Types:...

 caused by Acanthamoeba
Acanthamoeba
Acanthamoeba is a genus of amoebae, one of the most common protozoa in soil, and also frequently found in fresh water and other habitats. The cells are small, usually 15 to 35 μm in length and oval to triangular in shape when moving. The pseudopods form a clear hemispherical lobe at the anterior,...

. As a scrub, chlorhexidine is not recommended on persons under two months of age. Anionic ingredients in many leave-on topicals and cosmetics, including those in acne products, cleansers, and moisturizers, will inactivate it.

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. Note, however, that problems including deafness 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, anionic thickeners such as carbomer
Carbomer
In organic chemistry, a carbomer is an expanded molecule obtained by insertion of a C2 unit in a given molecule. Carbomers differ from their templates in size but not in symmetry when each C–C single bond is replaced by at least one alkyne bond, and when a double bond is replaced by an allene bond...

, and anionic emulsifiers such as acrylates/C10-30 alkyl acrylate crosspolymer, among many others. For this reason, chlorhexidine mouth rinses should be used at least 30 minutes after other dental products. For best effectiveness, food, drink, smoking, and mouth rinses should be avoided for at least one hour after use. Many topical skin products, cleansers, and hand santitizers should also be avoided to prevent deactivation when chlorhexidine (a topical itself or the residue from a cleanser) is meant to remain on the skin.

The rival chemical PCMX does not have this issue or the warnings about eye & middle-ear contact, though it is usually less potent in the form and concentrations normally used.

Although chlorhexidine is effective in the presence of blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

, real soap
Soap
In chemistry, soap is a salt of a fatty acid.IUPAC. "" Compendium of Chemical Terminology, 2nd ed. . Compiled by A. D. McNaught and A. Wilkinson. Blackwell Scientific Publications, Oxford . XML on-line corrected version: created by M. Nic, J. Jirat, B. Kosata; updates compiled by A. Jenkins. ISBN...

, and pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...

, its activity is reduced.

External links

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