Chlorhexidine

Introduction

Chlorhexidine is a bisbiguanide antiseptic and disinfectant that is bactericidal or bacteriostatic against a wide range of Gram-positive and Gram-negative bacteria.

  • It is more effective against Gram-positive than Gram-negative bacteria, and some species of Pseudomonas and Proteus have low susceptibility.
  • It is relatively ineffective against mycobacteria.
  • Chlorhexidine inhibits some viruses and is active against some fungi.
  • It is inactive against bacterial spores at room temperature.

Combinations of chlorhexidine with cetrimide or in alcoholic solution are used to enhance efficacy.



Uses

For pre-operative skin disinfection and hand-washing, chlorhexidine is used as a 0.5% solution of the acetate or gluconate in alcohol (70%) or as a 2 or 4% detergent solution of the gluconate.

  • Septi-Sol Solution (Ethanol 77% and Chlorhexidine Gluconate 0.5%)
  • Softa-Man CHG Cutaneous Solution (Chlorhexidine Gluconate 0.5% in Ethanol 80%)
  • SteriPrep (Chlorhexidine Gluconate 2% in Alcohol 70%)
  • Surgi Scrub, SurgiBath (Chlorhexidine Gluconate 4%)

For disinfection of wounds, burns, or other skin damage or disorders, chlorhexidine is used as a 0.05% aqueous solution of the acetate or gluconate, as a tulle dressing impregnated with chlorhexidine acetate 0.5%, or as a cream or powder containing chlorhexidine acetate or gluconate 1%. Preparations containing chlorhexidine acetate or gluconate 0.015% and cetrimide 0.15% are also used for cleansing and disinfection of skin and wounds.

  • Bactigras (Gauze dressing impregnated with paraffin, containing 0.5% Chlorhexidine Acetate)
  • Bacidin Antiseptic Cream (Chlorhexidine Gluconate 1%)
  • Bepathen First Aid Cream (Dexpanthenol 5% and Chlorhexidine HCl 0.5%)

In obstetrics, chlorhexidine gluconate is used as a 0.05% aqueous solution or a 1% cream.

  • Disinfection of the birth canal with chlorhexidine gluconate 0.05 to 0.4% during labour has been investigated as a method for reducing mother-to-child transmission of infections, including early-onset group B streptococcal infection and HIV.
  • Studies have shown that it has not reduced perinatal transmission of HIV except when membranes were ruptured for more than 4 hours before delivery or if used before the membranes rupture and at higher concentrations.

Chlorhexidine gluconate is used in a 1% dental gel, 0.2% oral spray, and 0.1 to 0.2% mouthwash for the prevention of plaque and the prevention and treatment of gingivitis and in the treatment of oral candidiasis.

  • Difflam-C Mouthwash (Benzydamine HCl 0.15% and Chlorhexidine Gluconate 0.12%)
  • Hexidine Mouthwash (Chlorhexidine Gluconate 0.2%)
  • Hexidine Topical Gel (Chlorhexidine Gluconate 1%)
  • Oradex Antibacterial Mouthwash (Chlorhexidine Digluconate 0.12%)
  • Oral Aid Lotion (Lignocaine 2.5%, Chlorhexidine 0.5% and Triamcinolone Acetonide 0.1%)

A 0.02% solution may be used as a bladder irrigation in some urinary-tract infections. A gel containing 0.25% chlorhexidine gluconate solution and lidocaine hydrochloride has been used in catheterisation and cystoscopy.

For the emergency disinfection of clean instruments, a 2-minute immersion in chlorhexidine acetate or gluconate 0.5% in alcohol (70%) is used; for the storage and disinfection of clean instruments a 30-minute immersion in a 0.05% aqueous solution containing 0.1% sodium nitrite to inhibit metal corrosion is used.

As an antimicrobial preservative, chlorhexidine is used at a concentration of 0.01% of the acetate or gluconate in eye drops. Solutions containing 0.002 to 0.006% of chlorhexidine gluconate have also been used for disinfection of hydrophilic contact lenses.



Summary

Chlorhexidine is formulated as

  • Lotions, washes, and creams for disinfection and cleansing of skin and wounds
  • Oral gels, sprays, and mouthwashes for mouth infections including candidiasis and to reduce dental plaque accumulation.



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