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PubMed2004

Children's acceptance and tolerance of chlorhexidine and benzydamine oral rinses in the treatment of chemotherapy-induced oropharyngeal mucositis.

Oral care is of great importance in the prevention of chemotherapy-induced oropharyngeal mucositis. Although considerable attention has been given in improving oral care practices, patients' acceptance and tolerance of oral rinses is a continuing problem in oral care. A randomized crossover design was used to determine the relative acceptability and tolerability of chlorhexidine and benzydamine oral rinse agents in children receiving chemotherapy. At the end of the study, each subject was asked to compare these two agents in relation to stinging and taste, as well as his/her perception in reducing mucositis. Thirty-four children aged 6-17 years completed two courses of chemotherapy during which they alternately practiced oral care using chlorhexidine then benzydamine or benzydamine then chlorhexidine. All of the children tolerated the agents well and continued with rinsing throughout the study. Only a few children had to resort to diluting the agents with normal saline or water. Fifty-nine percent of children reported that the stinging associated with benzydamine was more accepted than chlorhexidine. The taste of both these agents was accepted by 50% of children. Approximately 60% of children reported that chlorhexidine was more helpful than benzydamine in reducing mucositis. About 47% and 50% of them preferred chlorhexidine and benzydamine in their subsequent chemotherapy, respectively. In conclusion, chlorhexidine and benzydamine are acceptable and well-tolerated by children over the age 6 years old.

Adolescent↗

PubMed2005

Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study.

INTRODUCTION: The importance of skin preparation before regional nerve blockade to prevent infection remains unchallenged. A multi-use spray chlorhexidine may have benefits over single use sachets in terms of convenience and cost, but its efficacy is unknown. We conducted a prospective randomised trial to compare spray and sachet chlorhexidine. METHODS: Elective caesarean section patients were randomised to receive chlorhexidine as a spray (chlorhexidine 0.5% in an alcoholic solution Hydrex DS Derma spray, Adams Healthcare, Leeds, UK) or sachet chlorhexidine (chlorhexidine 0.05% aqueous solution, Unisept, Seton. Leeds, UK) before a standardised combined spinal epidural technique. Skin colonisation was examined before skin preparation and again after epidural catheter removal. RESULTS: Both techniques were effective in reducing skin colonisation (P=0.0001). There was no difference in effectiveness between the groups, with the spray reducing skin colonisation from 88.5% before to 3% after catheter removal, compared with 90% to 12% in the sachet group. Time to achieve skin preparation was significantly reduced in the spray group (2.6 min compared to 4.5 min; P=0.02). The spray cost per patient was 0.01 compared to sachet 0.33. CONCLUSIONS: We suggest a chlorhexidine spray is as effective as single use sachets and is also quicker to apply and less costly.

Adult↗

PubMed1998

Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants.

Sodium hypochlorite irrigant is known to be toxic to periapical tissues. Chlorhexidine gluconate, a safer and effective antimicrobial irrigant, is not known to dissolve pulpal tissues. To obtain their optimal properties, their combined action within the root canal was evaluated. Ten single rooted nonvital anterior teeth were irrigated using either 2.5% sodium hypochlorite alone, 0.2% chlorhexidine gluconate alone, 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate combined within the root canal, or 0.9% saline, respectively. Microbiological samples for culture and Gram's staining were taken before and proceeding irrigation. This study indicates that the use of sodium hypochlorite and chlorhexidine gluconate combined within the root canal resulted in the greatest percentage reduction of postirrigant positive cultures. This may be due to formation of "chlorhexidine chloride," which increases the ionizing capacity of the chlorhexidine molecule. This reduction was significant compared to use of sodium hypochlorite alone but not significant compared to use of chlorhexidine gluconate alone.

Anti-Infective Agents, Local↗

PubMed1984

Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria.

The antimicrobial potency of 4 per cent chlorhexidine gluconate was compared with that of 10 per cent povidone-iodine (1 per cent free iodine) on the vaginal bacteria of 150 premenopausal, non-pregnant women. From 30 of the women blood samples were taken before and at either 15, 30 or 60 minutes after vaginal cleansing with chlorhexidine for chlorhexidine analysis. Five minutes after applying either chlorhexidine or povidone-iodine almost 99 per cent of bacteria present on the lateral wall of the vagina were killed. Chlorhexidine was significantly more effective than povidone-iodine. Serosanguineous , mucoid or white-yellowish vaginal discharge did not alter the effectiveness of either antimicrobial agent. In contrast to povidone-iodine, vaginally applied chlorhexidine was not absorbed in measurable amounts (sensitivity of detection method: 0 X 1 mg/l) into the bloodstream. Chlorhexidine may therefore prove of value for treating vaginitis especially during pregnancy and also for combating microbes such as Group B streptococci which are potentially harmful to the newly-born child.

Absorption↗

PubMedDate not supplied

Effect of sub-inhibitory concentration of chlorhexidine on lipid and sterol composition of Candida albicans.

The effect of a sub-inhibitory concentration of chlorhexidine on lipid and sterol composition of Candida albicans was investigated. The total lipid content of this yeast grown in the presence of chlorhexidine was reduced whilst the total sterol content was increased compared with control-grown cells. Lipids and sterol analyses of this yeast grown in the presence and absence of chlorhexidine are presented. Chlorhexidine-grown yeast had a higher level of phosphatidylethanolamine, phosphatidylcholine and monogalactosyldiacylglycerol. Lower proportions of phosphatidylinositol plus phosphatidylserine, phosphatidic acid and cardiolipin were found in C. albicans grown in the presence of the drug when compared with control-grown yeast. The major fatty acids in control-grown cells were C16 and C18. Drug grown-cells had higher proportions of palmitic acid (16:0) and stearic acid (18:0), but lower proportions of palmitoleic acid (16:1) and oleic acid (18:1). Chlorhexidine also decreased the unsaturated-to-saturated fatty acid ratio, while the C16/C18 ratios increased compared to control-grown cells. Differences in the fatty acid composition of major phospholipids and neutral lipids between drug and control-grown yeast were also detected. Sterol analysis of control-grown cells showed that the major sterol present was ergosterol (55.4% wt). A significant increase in ergosterol and obtusifoliol was observed in chlorhexidine-treated cells and a significant decrease in squalene and lanosterol. Our results suggested that chlorhexidine affected the lipid and sterol composition of C. albicans.

Anti-Infective Agents, Local↗

PubMed2002

Anti-plaque effect of tempered 0.2% chlorhexidine rinse: an in vivo study.

OBJECTIVES: The aim of this in vivo study was to compare the anti-plaque effect of warm and cold chlorhexidine gluconate irrigation on matured human plaque. METHODS: In a split-mouth design, the antibacterial effect of 47 degrees C "warm" 0.2% chlorhexidine solution was compared with that of 18 degrees C "cold" rinse at the same concentration on newly-formed supragingival plaque that had been left undisturbed for 72 h. Before and 1 h after a 1-min rinse procedure, plaque was sampled from 10 test persons and vitality determined using vital fluorescence technique. RESULTS: Cold and warm 0.2% chlorhexidine solution reduced plaque vitality significantly from 99.63% to 77.81% (p=0.014) and from 98.98% to 51.77% (p<0.001), respectively. Rinsing with warm chlorhexidine solution reduced plaque vitality to a significantly greater degree (p=0.003) than did cold chlorhexidine. CONCLUSION: In this study, warm 0.2% chlorhexidine rinse showed a significantly more intensive anti-plaque effect than cold chlorhexidine solution at the same concentration.

Adult↗

PubMed1986

A comparison of the effects of chlorhexidine gluconate, amphotericin B and nystatin on the adherence of Candida species to denture acrylic.

Pretreatment of denture acrylic with nystatin, amphotericin B and chlorhexidine gluconate significantly reduced the subsequent adherence of Candida species to acrylic, although chlorhexidine and nystatin were more effective than amphotericin B. The duration of chlorhexidine-mediated inhibition of adherence (up to 19 days) was much longer than that of amphotericin B (24 h) or nystatin (48 h). Exposure of stationary-phase cells of Candida species for a short period to sublethal concentrations of chlorhexidine, or growth of Candida species with sublethal concentrations of chlorhexidine for 24 h resulted in a reduction in the ability of the yeasts to adhere to denture acrylic. The organisms grown in the presence of chlorhexidine were more susceptible to spheroplasting with Zymolyase 20T, indicating that chlorhexidine affects the cell surface composition of Candida species.

Acrylic Resins↗

PubMed1990

The effect of sub-inhibitory concentrations of chlorhexidine on the proteolytic activity of Bacteroides gingivalis.

Bacteroides gingivalis was grown in the presence of chlorhexidine at concentrations lower than the minimum inhibitory concentration (1.25 mg/l). These sub-inhibitory concentrations were found to stimulate growth in terms of an increase in the number of viable cells, the greatest increase being at a concentration of 0.75 mg/l of chlorhexidine. The total proteolytic activity of the cultures (assayed by means of azocasein hydrolysis) grown in the presence of chlorhexidine and their specific activities (per 10(6) cells) were found to be less than those of the cultures grown in the absence of chlorhexidine. In the case of the trypsin-like activity of the microorganism, a different pattern was found. Thus, although the specific activities of the chlorhexidine-grown cultures were lower than those of the chlorhexidine-free cultures, the total activity in the chlorhexidine-grown cultures was greater.

Bacteroides↗

PubMed2000

Effect of chlorhexidine on genital microflora, Neisseria gonorrhoeae, and Trichomonas vaginalis in vitro.

BACKGROUND: Chlorhexidine is a disinfectant that has been used in skin and mouth washes and as a preservative in some vaginal lubricants. A gel containing 0.25% chlorhexidine gluconate has been found to be effective against Chlamydia trachomatis in vitro and in animal models. Applied vaginally, 5 g of this gel could achieve vaginal fluid concentrations of < or = 1250 microg/ml. GOAL: To test the in vitro activity of chlorhexidine in a gel over a pH range of 4 to 8 in the presence or absence of blood. STUDY DESIGN: Organisms were exposed to chlorhexidine for 30 minutes to 2 hours, and the minimum cidal concentration (MCC) was calculated. RESULTS: The MCC for Neisseria gonorrhoeae was 25 microg/ml at 30 minutes and 12.5 microg/ml at 1 to 2 hours of exposure, whereas the MCC for Trichomonas vaginalis was 1250 microg/ml. Chlorhexidine was more active at pH 8 than pH 4, and less active in the presence of blood. The MCC for Lactobacillus crispatus was 1250 microg/ml at pH 4 and only 125 microg/ml at pH 8. CONCLUSIONS: Based on its in vitro activity, chlorhexidine may be an appropriate topical microbicide for prevention of gonorrhea, but not for prevention of trichomoniasis. This study suggests that the presence of blood and pH affect the activity of chlorhexidine against genital pathogens and commensals.

Animals↗

PubMed2006

Use of vaginally administered chlorhexidine during labor to improve pregnancy outcomes.

OBJECTIVE: Our objective was to determine the potential for chlorhexidine used as a vaginal and neonatal wash to reduce adverse outcomes of pregnancy, especially in developing countries. DATA SOURCES: We searched the English literature from January 1950 through October 2005 for all articles related to the use of chlorhexidine. METHODS OF STUDY SELECTION: Every article on chlorhexidine use in pregnancy and in the newborn period was reviewed in detail. The results of every study in which chlorhexidine was used as a vaginal treatment, with or without a neonatal wash, for all pregnancy outcomes except mother-to-child transmission of human immunodeficiency virus, are summarized in this review. TABULATION, INTEGRATION AND RESULTS: Chlorhexidine is a highly effective killer of most bacteria, has an excellent safety profile, rarely is associated with bacterial resistance, is easy to administer, and costs a few cents per application. When used as a vaginal or newborn disinfectant, it clearly reduces bacterial load, including transmission of Group B Streptococcus from the mother to the fetus. Nevertheless, in developed countries, chlorhexidine generally has not been shown to significantly reduce life-threatening maternal or neonatal infections. However, 2 large but not randomized studies, one in Malawi and the other in Egypt, suggest that important reductions in maternal and neonatal sepsis and neonatal mortality may be achievable with vaginal or neonatal chlorhexidine treatment. CONCLUSION: With 4 million neonates and about 700,000 pregnant or recently pregnant women-mostly in developing countries-dying each year, many from infections originating in the vagina, further study of this highly promising treatment is indicated.

Administration, Intravaginal↗

PubMed2006

Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries.

Affordable, efficacious, and safe interventions to prevent infections and improve neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-spectrum antiseptic that has been used extensively for many decades in hospital and other clinical settings. It has also been given as maternal vaginal lavage, full-body newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates. Recent evidence suggests that these chlorhexidine interventions may have significant public health impact on the burden of neonatal infection and mortality in developing countries. This review examines the available data from randomized and nonrandomized studies of chlorhexidine cleansing, with a primary focus on potential uses in low-resource settings. Safety issues related to chlorhexidine use in newborns are reviewed, and future research priorities for chlorhexidine interventions for neonatal health in developing countries are discussed. We conclude that maternal vaginal cleansing combined with newborn skin cleansing could reduce neonatal infections and mortality in hospitals of sub-Saharan Africa, but the individual impact of these interventions must be determined, particularly in community settings. There is evidence for a protective benefit of newborn skin and umbilical cord cleansing with chlorhexidine in the community in south Asia. Effectiveness trials in that region are required to address the feasibility of community-based delivery methods such as incorporating these interventions into clean birth kits or training programs for minimally skilled delivery assistants or family members. Efficacy trials for all chlorhexidine interventions are needed in low-resource settings in Africa, and the benefit of maternal vaginal cleansing beyond that provided by newborn skin cleansing needs to be determined.

Anti-Infective Agents↗

PubMed1989

The incidence of IgE and IgG antibodies to chlorhexidine.

IgE antibodies to the antiseptic agent chlorhexidine have recently been detected in the majority of sera from a small group of predominantly Japanese individuals showing anaphylactic-type adverse reactions towards chlorhexidine. In this study the prevalence of IgE and IgG antibodies with specificity for chlorhexidine was investigated in groups of Japanese and British individuals. The RAST data, using a better defined semi-chlorhexidine-HSA antigen than previously employed, revealed that chlorhexidine-specific IgE was only detected in Japanese individuals who had experienced anaphylactic-type reactions and was not detected in groups of Japanese nurses and patients, or in groups of British nurses and hospital staff, all in regular contact with chlorhexidine. A group of British blood donors was also negative. In contrast, IgG antibodies were detected not only in sera from chlorhexidine-sensitive Japanese patients, but also in several sera from Japanese nurses, non-sensitive Japanese patients and several British individuals. The possible reasons for these observations are discussed.

Adult↗

PubMed1989

The effects of chlorhexidine on the maximum specific growth rate, biomass and hydrolytic enzyme production of Bacteroides gingivalis grown in continuous culture.

Bacteroides gingivalis was grown in continuous culture in the presence of chlorhexidine. Maximum specific growth rates and biomass levels initially increased but then decreased as the chlorhexidine level increased from 0 to 30 micrograms/ml. Total inhibition of growth occurred when the chlorhexidine concentration reached 60 micrograms/ml. The steady-state levels of cell-bound, extracellular vesicle and extracellular soluble enzymes, trypsin-like protease, alkaline phosphatase and N-acetyl-beta-glucosaminidase were measured. With increasing sub-lethal concentrations of chlorhexidine, levels of alkaline phosphatase increased noticeably in all three fractions of culture, whilst cell-bound and extracellular vesicle levels of N-acetyl-beta-glucosaminidase remained approximately constant. Extracellular soluble levels of alkaline phosphatase and N-acetyl-beta-glucosaminidase increased with increasing levels of chlorhexidine. The levels of trypsin-like protease decreased significantly in all fractions of the culture when cells were grown in the presence of chlorhexidine. Thus, chlorhexidine has a differential effect on the production of B. gingivalis hydrolytic enzymes.

Acetylglucosaminidase↗

PubMedDate not supplied

Effects of chlorhexidine diacetate and povidone-iodine on wound healing in dogs.

To correlate the results of an in vitro study with clinical response, the effects of 0.005 and 0.05% chlorhexidine diacetate and 0.1 and 1.0% povidone-iodine concentrations on wound healing were evaluated in five beagle dogs. Full-thickness skin wounds (2 X 2 cm) were irrigated once daily for 14 days with the antiseptic solutions or physiologic-buffered saline. Chlorhexidine diacetate 0.05% had significantly more bactericidal activity than povidone-iodine and saline, and both chlorhexidine diacetate concentrations had residual effects 6 hours after irrigation. Neither povidone-iodine nor saline had significant bactericidal activity. The percentages of unhealed wound area and wound contraction were calculated 7, 14, and 21 days after wounding. Healed wound area and contraction were similar in wounds treated with chlorhexidine diacetate and povidone-iodine. However, wounds treated with chlorhexidine diacetate had more healed wound area on days 7 and 14 and more contraction on days 7, 14, and 21 than saline-treated wounds. At the concentrations tested, chlorhexidine diacetate irrigations provided bactericidal activity and were more beneficial to wound healing than irrigations with saline alone. These results suggest that concentrations of chlorhexidine diacetate which are cytotoxic to tissue culture fibroblasts in vitro do not interfere with wound healing in vivo.

Animals↗

PubMedDate not supplied

Effects of 0.05% chlorhexidine lavage on the tarsocrural joints of horses.

In six horses, a 0.05% solution of chlorhexidine diacetate was used to lavage one tarsocrural joint; the contralateral control joint was lavaged with lactated Ringer's solution. Horses were evaluated daily for lameness. Synovial fluid samples were collected on days 1, 4, and 8 for determination of protein concentration, total and differential leukocyte counts, and mucin clot formation. After death on day 8, synovium and osteochondral samples were collected from the tarsocrural joints for examination of morphology and proteoglycan staining. Lavage with chlorhexidine solution caused lameness that was reduced but still evident at day 8. Synovial protein concentration was significantly increased by chlorhexidine lavage; the greatest increase occurred on day 1. Joint lavage increased synovial leukocyte counts on day 1, primarily by increasing polymorphonuclear (PMN) cell counts. Although total synovial leukocyte counts returned to normal by day 4, PMN cell counts remained elevated through day 8; PMN cell counts for chlorhexidine-lavaged joints were typically twice that of control joints. Chlorhexidine lavage caused synovial ulceration, inflammation, and abundant fibrin accumulation. Consistent differences in proteoglycan staining were not detected between control and chlorhexidine-lavaged joints. Joint lavage with 0.05% chlorhexidine diacetate, the lowest known bactericidal concentration, is not recommended for equine joints.

Animals↗

PubMed1983

Use of chlorhexidine as a plaque control measure following surgical treatment of periodontal disease.

Chlorhexidine mouth rinsing was compared with regularly performed professional tooth cleaning as a plaque control measure during healing following periodontal surgery. 14 patients were selected for the study. A Baseline examination included assessment of oral hygiene status, gingival condition, probing depth and attachment level. In each patient, scaling and root planing was carried out in conjunction with the modified Widman flap procedure including recontouring of alveolar bone irregularities in 2 jaw quadrants. The same procedures without osseous surgery were performed in contralateral jaw quadrants. 7 patients rinsed their mouth with a solution of 0.2% chlorhexidine digluconate twice a day, 2 min each time, for the first 6 months after therapy (healing phase). During the same period the remaining 7 patients were recalled every 2 weeks for professional tooth cleaning ad modum Axelsson & Lindhe (1974). Following reexamination after 6 months, all 14 patients were placed on a maintenance care program which included mechanical prophylaxis once every 3 months for 18 months (maintenance phase). Reexaminations were performed 6, 12 and 24 months after completion of initial therapy. The results revealed that professional tooth cleaning was somewhat more effective as a plaque control measure during healing following surgery than chlorhexidine mouth rinsing. At the end of the healing phase (1) there was a higher frequency of sites with pockets deeper than 4 mm in the patients who rinsed with chlorhexidine, (2) less gain of attachment occurred following chlorhexidine rinsing in pockets with an initial probing depth of greater than 4 mm, and (3) attachment loss in initially shallow pockets was somewhat more pronounced in the patients who rinsed with chlorhexidine. The differences in the effect of the 2 methods of plaque control, however, were small and in most respects diminished in the course of the maintenance phase. It was concluded that mouth rinsing with chlorhexidine is a proper alternative to plaque control during healing following periodontal surgery.

Adult↗

PubMed1991

Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children.

The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).

Adolescent↗

PubMed1993

A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining.

Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.

Adolescent↗