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PubMed1993

The effect of chlorhexidine irrigation on tensile wound strength.

Chlorhexidine in an alcohol vehicle with flavoring agents has been used as a mouthrinse to reduce plaque accumulation in periodontal surgery patients. The purpose of this study was to evaluate the effects of a chlorhexidine-containing mouthrinse on the early tensile wound strength of healing surgical wounds in the rat. Standardized transdermal incisions were made on each lateral abdominal wall of 40 Sprague-Dawley rats. Wounds were irrigated with 10 ml of 0.12% chlorhexidine or 10 ml of normal saline prior to closure. Animals were sacrificed at 48 hours and 96 hours, and the wound area was excised by a standardized protocol. Wound strength was measured using constant speed tensiometry to determine the tensile strength of the healing incision. Results revealed a significantly reduced tensile wound strength at 48 hours for the chlorhexidine-treated group (127 +/- 18.5 gm) compared to the saline irrigation group (150 +/- 32.3 gm) (P < 0.001). However, by 96 hours a significantly increased tensile wound strength was demonstrated by the chlorhexidine treated group (202.1 +/- 21.7 gm) compared to the saline irrigation group (183.2 +/- 37.3 gm) (P < 0.05). These data suggest that chlorhexidine-containing mouthrinse irrigation of wounds produced a reduced early tensile wound strength, but ultimately resulted in shorter healing time.

Analysis of Variance↗

PubMed2006

A systematic review on the effects of the chlorhexidine chip when used as an adjunct to scaling and root planing in the treatment of chronic periodontitis.

BACKGROUND: Several local antimicrobial agents, such as a bioabsorbable chlorhexidine chip, have been developed to enhance the outcome of non-surgical periodontal therapy. METHODS: Electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual searches were performed to detect studies concerning the use of the chlorhexidine chip as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Only full-text randomized controlled trials published in English up to June 2005 were included. RESULTS: Five studies were finally selected following independent screening by two reviewers. Due to considerable heterogeneity in study design, a qualitative data analysis was performed. Multicenter studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of mechanical debridement and repeated chlorhexidine chip administration in comparison to scaling and root planing alone. However, some recent studies failed to confirm the additional value of the chlorhexidine chip. A number of interstudy disparities with respect to methodological quality and study design may account for this lack of accordance. CONCLUSIONS: The clinical and microbiological data currently available on the chlorhexidine chip are limited and conflicting. More research is needed to elucidate the additional value of the chlorhexidine chip when used as an adjunct to scaling and root planing.

Absorbable Implants↗

PubMed2001

Effects of chlorhexidine digluconate and hydrogen peroxide on Porphyromonas gingivalis hemin binding and coaggregation with oral streptococci.

Porphyromonas gingivalis, a gram-negative anaerobe, is one of the major causative agents of periodontal disease. In this study, the effects of chlorhexidine digluconate and hydrogen peroxide on the hemin binding of P. gingivalis and coaggregation of this bacterium with oral streptococci were examined. The pretreatment of P. gingivalis W50 and 381 with chlorhexidine digluconate and hydrogen peroxide increased the hemin binding of these bacteria. The hemin binding of P. gingivalis was increased by the subminimal inhibitory concentration (MIC) of chlorhexidine digluconate. However, concentrations of hydrogen peroxide below the MIC had no effect on the hemin binding of P. gingivalis W50 and 381. Coaggregation of P. gingivalis 381 with Streptococcus oralis ATCC 9811 and Streptococcus gordonii DL1 was diminished by chlorhexidine digluconate. The coaggregation-inhibitory effect was concentration-dependent. Hydrogen peroxide also showed inhibitory effects on the coaggregation of P. gingivalis 381 with S. oralis 9811 and S. gordonii DL1 at concentrations below that used clinically. Concentrations of chlorhexidine digluconate below the MIC inhibited coaggregation. However, concentrations of hydrogen peroxide below the MIC were not effective in reducing the coaggregation of P. gingivalis with oral streptococci. These observations show that chlorhexidine digluconate and hydrogen peroxide could confer variable effects on P. gingivalis hemin binding and coaggregation of this bacterium with oral streptococci.

Anti-Infective Agents, Local↗

PubMed1975

Denture stomatitis. The clinical effects of chlorhexidine and amphotericin B.

The clinical effects of an antibacterial substance with antifungal activity (chlorhexidine) and specific antimycotic (amphotericin B) in denture stomatitis were studied in 100 patients. Five 14-day regimens of chlorhexidine, amphotericin B or placebo lozenges combined with denture immersion in 0.2% chlorhexidine or water were tested. The efficiency of amphotericin B and chlorhexidine was comparable. This indicates that chlorhexidine has a considerable antifungal effect in the oral cavity and, further, that fungi are the responsible micro-organism in denture stomatitis rather than bacteria. Chlorhexidine frequently discloured the dentures. A high incidence of local and general predisposing factors to denture stomatitis, as well as of relapse 14 days after treatment, was observed.

Amphotericin B↗

PubMed1981

Effect of chlorhexidine on the release of lysosomal enzymes from cultured macrophages.

Exposure of rat's peritoneal macrophages to chlorhexidine at concentrations up to 0.01 per cent resulted in the release of lysosomal enzymes, e.g. chloride-dependent arginine aminopeptidase and beta-D-glucuronidase into the medium from resting cells. The activity of extracellular lactate dehydrogenase increased up to the concentration of 0.01% and then decreased with increasing chlorhexidine concentration. This could indicate a certain type of "mummifying" of the cells and/or their membranes. The incorporation of trypan blue was found in all cells after a rinse with 0.05 per cent or higher concentrations of chlorhexidine. The direct effect of chlorhexidine on these enzyme activities showed a slight activation of beta-D-glucuronidase and lactate dehydrogenase, but an inhibition of arginine aminopeptidase. Also the binding of chlorhexidine to cells was found. Low chlorhexidine concentrations caused an additional enzyme release from phagocytizing cells.

Aminopeptidases↗

PubMed1997

Trial of chlorhexidine gluconate for fungal corneal ulcers.

AIMS: Suppurative corneal ulcers due to filamentous fungi are a serious and intractable problem in many tropical developing countries. In vitro studies and a small pilot study have shown that chlorhexidine gluconate is effective. The aim was to establish the optimum concentration which would be appropriate to use in a larger randomized clinical trial. METHODS: A masked randomized clinical trial of three concentrations of chlorhexidine compared with natamycin 5% was carried out in consecutive patients with established corneal ulcers shown by microscopy to contain fungal hyphae and later proven to be culture positive. Topical treatments were applied 1/2-hourly to 2-hourly for up to 5 days, with reduced frequency thereafter, and all patients were re-assessed at 21 days. RESULTS: Of 60 patients entered in the trial, 2 were lost to follow-up, and 12 were classified as 'severe' with little prospect of recovery. At 5 days the response was related to the concentration of chlorhexidine, with 0.2% giving the best results. Compared with the response to natamycin as the referent, the relative efficacy was 1.17 with chlorhexidine 0.05%, 1.43 with 0.1%, and 2.00 with 0.2%. The superiority of 0.2% chlorhexidine over natamycin was statistically significant (relative efficacy 2.20, p = 0.043) in patients not having had prior antifungal treatment. CONCLUSIONS: This preliminary study justifies further trials of chlorhexidine as a primary treatment for fungal corneal ulcers in circumstances where specific antifungal agents are not available.

Administration, Topical↗

PubMed1999

Chlorhexidine compared with povidone-iodine as skin preparation before blood culture. A randomized, controlled trial.

BACKGROUND: Chlorhexidine is better than povidone-iodine for care of catheter sites, but it is not known whether chlorhexidine is superior in reducing blood culture contamination. OBJECTIVE: To determine whether alcoholic chlorhexidine is a more effective skin antiseptic for collection of blood cultures than aqueous povidone-iodine. DESIGN: Randomized, controlled trial. SETTING: Three adult intensive care units in a French university hospital. PATIENTS: 403 adults who had at least one blood culture drawn through a peripheral vein. INTERVENTIONS: Patients were randomly assigned to receive skin preparation with an aqueous solution of 10% povidone-iodine or an alcoholic solution of 0.5% chlorhexidine before phlebotomy. MEASUREMENTS: Contamination rates of blood cultures. RESULTS: Of 2041 blood cultures collected in 403 patients, 124 yielded pathogens. Chlorhexidine reduced the incidence of blood culture contamination more than povidone-iodine (14 of 1019 cultures [1.4%] compared with 34 of 1022 cultures [3.3%]; odds ratio, 0.40 [95% CI, 0.21 to 0.75]; P = 0.004). CONCLUSION: Skin preparation with alcoholic chlorhexidine is more efficacious than skin preparation with aqueous povidone-iodine in reducing contamination of blood cultures.

Adult↗

PubMed2002

Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis.

PURPOSE: Bloodstream infections related to use of catheters, particularly central-line catheters, are an important cause of patient morbidity, mortality, and increased health care costs. This study evaluated the efficacy of skin disinfection with chlorhexidine gluconate compared with povidone-iodine solution in preventing catheter-related bloodstream infection. DATA SOURCES: Multiple computerized databases (1966 to 2001), reference lists of identified articles, and queries of principal investigators and antiseptic manufacturers. STUDY SELECTION: Randomized, controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for catheter-site care. DATA EXTRACTION: Using a standardized form, two reviewers abstracted data on study design, patient population, intervention, and incidence of catheter-related bloodstream infection from all included studies. DATA SYNTHESIS: Eight studies involving a total of 4143 catheters met the inclusion criteria. All studies were conducted in a hospital setting, and various catheter types were used. The summary risk ratio for catheter-related bloodstream infection was 0.49 (95% CI, 0.28 to 0.88) in patients whose catheter sites were disinfected with chlorhexidine gluconate instead of povidone-iodine. Among patients with a central vascular catheter, chlorhexidine gluconate reduced the risk for catheter-related bloodstream infection by 49% (risk ratio, 0.51 [CI, 0.27 to 0.97]). CONCLUSIONS: These results suggest that incidence of bloodstream infections is significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for insertion-site skin disinfection. Use of chlorhexidine gluconate is a simple and effective means of reducing vascular catheter-related infections.

Aged↗

PubMed1976

[The effectiveness of a chlorhexidine (Plak-out) gel and solution: clinical study].

A gel containing 0.2% chlorhexidine gluconate has been utilized during 6 weeks as a toothpast 3 times a day by a group of 8 students, while 8 other volonteers have brushed their teeth with a gel placebo. The gingival and plaque indices, as well as the amount of gingival fluid have been measured at the beginning and at the end of the experimental time. Colour photographs were also taken. The study, performed in double blind, did not show any significant change in the gingival conditions of the 16 students. In a second trial, the antiplaque properties of a chlorhexidine containing solution (Plak-out liquid) were tested. After thorough prophylaxis, 13 students in an experimental group and 8 students in a placebo group were asked to stop their oral hygiene procedures during 7 days and to rinse their mouth 2 times a day during 1 minute with the chlorhexidine solution or with the placebo. In each of the 2 groups, 4 subgroups were formed, each rinsing the mouth with a chlorhexidine or a placebo concentration of 0.05, 0.1, 0.15 and 0.2 per cent. In the experimental group the results show a practically complete inhibition of plaque deposits. The average plaque index, which amounted to 0.3 at the beginning of the experiment in the 2 groups, showed an increase to 1.2 in the placebo group and dropped to 0.2 in the chlorhexidine group. The plaque inhibition seems to take place as a function of the chlorhexidine concentration. The gingival index of inflammation and the amount of gingival fluid showed an increase in the placebo group but did not change in the volonteers using the active compound.

Adult↗

PubMed2001

[Examination of liquid crystalline gel systems containing chlorhexidine on the structure and the drug release].

The aim of the thesis was to examine liquid crystalline gel systems as novel, locally applied drug delivery systems. For developing liquid crystalline vehicle, different ratio of Synperonic A7--water mixtures was prepared. Chlorhexidine, chlorhexidine acetate and chlorhexidine gluconate were used as model drugs. Liquid crystalline structure, drug release and drug release kinetic of the samples were studied at increasing surfactant concentration and the effect of the different drugs on the physicochemical properties of the samples and on the membrane transport was examined. For the analysis of the prepared liquid crystalline systems polarising microscopy, rheology test, differential scanning calorimetry, small-angle neutron scattering and transmission electron microscopy were carried out. The drug release and membrane transport experiments were performed by Franz type vertical diffusion cell and Sartorius Resorptionsmodell apparatus. According to our results liquid crystalline vehicles of lamellar and hexagonal structure formed by increasing the surfactant concentration. The drug release studies indicated, that the kinetic of the release strongly depend on the liquid crystalline structure, zero order release occurs from hexagonal structures and anomalous transport occurs from lamellar structures. The addition of chlorhexidine species to the systems modified the structure of the liquid crystalline system. As a results of liquid crystal-drug interaction the solubility of chlorhexidine base and its diffusion through lipophilic membranes increased in comparison with those of the chlorhexidine salts.

Calorimetry, Differential Scanning↗

PubMed2002

[Reduction of stain, plaque and gingivitis by mouth rinsing with chlorhexidine and peroxyborate].

Aim of the present study was to investigate whether the use of an oxidising mouthrinse as an adjunct to chlorhexidine is efficacious in reducing stain, plaque and gingivitis. This study had a single-blind, 2-group parallel design, including a 14-day experimental non-brushing period during which 1 group (n = 14) used chlorhexidine alone (CHX) and the other (n = 14) used chlorhexidine in combination with an oxidising agent. Patients were randomly assigned to either group. The gingival condition was evaluated at baseline by means of bleeding on marginal probing. The examination after 14 days of rinsing included the evaluation of plaque, bleeding on marginal probing and stain (GMSI: gingival modification of the stain index). The results showed at day 14 a significant difference between the 2 groups for plaque and gingival bleeding. The proportion of stained surfaces was less in the CHX + PER-group (28%), than in the chlorhexidine group. The adjunctive use of an oxidising agent peroxyborate to chlorhexidine, proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of gingivitis.

Adult↗

PubMed2003

[The observation of the effect of metronidazole-chlorhexidine solution on treatment of periapical periodontitis].

OBJECTIVE: To observe the effect of metronidazole-chlorhexidine solution on treatment of periapical periodontitis. METHODS: 202 teeth suffering from chronic periapical periodontitis were selected and divided into two groups. One group including 102 teeth were treated with metronidazole-chlorhexidine solution. Another group including 100 teeth were treated with formocresol. The acute symptoms during root canal therapy were observed. 164 teeth suffering from acute periapical periodontitis were also selected and divided into two groups. One group including 80 teeth were treated with metronidazole-chlorhexidine solution. Another group including 84 teeth were treated as the above except the pulp chamber keeping open. The other 44 teeth, in which purulence also presented in the root canal after treated with formocresol and iodoform for three times or more, were treated with metronidazole-chlorhexidine solution. The presence of purulence was evaluated. RESULTS: There are significant differences between the two groups of chronic and acute periapical periodontitis(P<0.05). The effective rate was 97.6% after changed to metronidazole-chlorhexidine solution treatment. CONCLUSION: Good treatment effect could be achieved by using metronidazole-chlorhexidine solution as the root canal cleaning and disinfection agent.

Adolescent↗

PubMed2004

Immediate hypersensitivity to chlorhexidine: literature review.

Chlorhexidine, an antiseptic belonging to family of biguanides, is used extensively in the medical and surgical environment. Late onset hypersensitivity and eczema occur regularly and are well documented events. Conversely, immediate hypersensitivity, sometimes taking the form of acute urticaria that can result in anaphylactic shock, is rarer. These manifestations can occur during contact of the skin or mucosa with chlorhexidine. Out of the fifty case reports of chlorhexidine-related anaphylaxis published worldwide over the past ten years, fifteen occurred during surgery. Signs generally appear from 15 to 45 minutes after the start of anesthesia. If there is any suspicion of immediate allergy to chlorhexidine, prick-tests or even intradermal reaction (IDR) techniques are highly recommended. In the event of confirmed allergy to chlorhexidine, strict eviction is required, bearing in mind that over a hundred medicinal products currently on the French market contain chlorhexidine.

Anaphylaxis↗

PubMedDate not supplied

Comparison of a phenolic and a 0.2% chlorhexidine mouthwash on the development of plaque and gingivitis.

Chlorhexidine and phenolic mouthrinses have attracted considerable interest as adjuncts to oral hygiene. The aim of this study was to compare two well known proprietary mouthrinse products for their effects on plaque regrowth, the development of gingivitis and the formation of toothstaining. The study was a single-blind, randomized, placebo-controlled, triple cross-over experimental, gingivitis design. A group of 15 volunteers with a very high standard of oral hygiene and gingival health used each rinse for 19 days in the absence of normal toothcleaning. Each period was separated by a 21 day washout. Plaque scores were significantly different between the rinses, being lowest with chlorhexidine and highest with saline. The plaque area increased 3-fold with the phenolic rinse and 6-fold with the saline rinse compared to the chlorhexidine rinse. Similarly, gingivitis increments were lowest with chlorhexidine and highest with saline but differences between rinses did not reach significance. Staining was significantly different between rinses, primarily due to minimal staining associated with the saline rinse. Staining occurred with both the chlorhexidine and phenolic mouthrinses. It is concluded that the 0.2% chlorhexidine rinse offers greater oral hygiene benefits than the phenolic rinse. The question of indications and durations of use of mouthwash products should be addressed.

Adult↗

PubMed1981

Chlorhexidine resistance in Escherichia coli isolated from clinical lesions.

Clinical isolates of Escherichia coli (148 strains) were studied for their resistance to chlorhexidine, six antibiotics and three metals. The distribution pattern of their susceptibility to chlorhexidine clearly revealed two peaks, and the resistance was differentiated by 5 micrograms/ml of chlorhexidine. Resistance to chlorhexidine was found in 12.8% of the isolates. The frequencies of resistance to SM, TC, CP, KM, CER, GM, Hg, Cd and As were 43.2, 36.4, 18.9, 25.0, 16.2, 4.1, 35.1, 91.2 and 47.2%, respectively. The frequency of chlorhexidine resistance was lower than that of drug and metal resistance except in the case of GM resistance. Furthermore, all of these chlorhexidine-resistant strains were multiple-drug-resistant also multiple-metal-resistant.

Anti-Bacterial Agents↗

PubMed1998

[Anaphylactoid shock caused by chlorhexidine gluconate].

We report two cases of anaphylactoid shock caused by chlorhexidine gluconate. Both patients had skin flare, severe hypotension and increased airway pressure during cannulation of an antibacterial IVH catheter containing chlorhexidine gluconate after skin sterilization with chlorhexidine gluconate. In case 1, we did not identify the mechanism and causative drugs. In case 2, an intradermal test to chlorhexidine gluconate was positive 2 months later. Then we confirmed that the anaphylactoid shock was caused by chlorhexidine gluconate. We should bear in mind the risk of anaphylactoid shock when we use chlorhexidine gluconate or the IVH catheter containing the bactericide.

Adult↗

PubMed1998

[Two patients with chlorhexidine allergy--anaphylactic reactions and eczema].

A 14 year-old girl experienced a combined delayed and immediate type of allergy to chlorhexidine. She first developed an eczematous reaction in the face following the long-term application of an antiacne preparation. Use test (repeated Open Application Test, ROAT) on the forearm was positive. Epicutaneous tests with 1% chlorhexidine gluconate and acetate were both positive. About six months later she developed an urticarial rash and syncope after cleansing the skin with chlorhexidine gluconate. Prick tests were positive to 0.05% chlorhexidine gluconate and to 0.01% of the acetate solution. A 30 year-old man developed anaphylactic symptoms following treatment with an antiseptic dental gel containing 1% chlorhexidine gluconate. Prick test was positive to the gel and to chlorhexidine gluconate 0.5%.

Adolescent↗

PubMed1980

Chlorhexidine effects on corneal epithelium and endothelium.

Chlorhexidine digluconate, a soft contact lens disinfectant, was perfused over rabbit corneal peithelial and endothelial surfaces under a variety of concentrations and conditions. Without protein in the bathing solutions, the cornea swelled when chlorhexidine concentrations of 20 microgram/mL or greater were perfused over the endothelium. Scanning electron microscopy demonstrated rounded, swollen cells with loss of microvilli. Perfusion of the epithelium with chlorhexidine in protein-free Ringer's solution resulted in a dose-dependent sloughing of cells and loss of microvilli, which resulted in little or no swelling when the endothelium was concomitantly bathed with oil. Corneal swelling followed at concentrations of 500 and 1,000 microgram/mL when both corneal surfaces were bathed with protein-free Ringer's solution and the epithelium was perfused with chlorhexidine. With protein included in the bathing solution, no swelling occurred when separate chlorhexidine (500 microgram/mL) and albumin (1%) solutions were applied simultaneously to the epithelial surface of corneas, with the endothelial surface bathed in Ringer's solution.

Animals↗