Chlorhexidine inflammation

Posted on by admin

Chlorhexidine - the antiseptic that conquered the world

Medicines with fully proven effectiveness, which cause not controversy in the medical community, but awe and awe, are, unfortunately, a very rare occurrence.

Table of contents:

And this group of unconditional and recognized drugs includes the familiar Chlorhexidine.

Before you continue reading: If you are looking for an effective method of getting rid of a runny nose, pharyngitis, tonsillitis, bronchitis or colds, then be sure to look at this section of the site after reading this article. This information has helped so many people, we hope it will help you too! So, now back to the article.

Behind the nondescript packaging and low price lies the real leader among antiseptics presented on the shelves of our pharmacies. If domestic brilliant green or, for example, Miramistin, remain exclusively Russian medicines, then Chlorhexidine is a generally recognized drug that is used all over the world.

Let's try to figure out together what is the secret of the popularity of this product. And at the same time, find out all about the pitfalls that may be hidden in the instructions for Chlorhexidine - side effects and possible contraindications.

A long story that has no end

Chlorhexidine has been used for almost 60 years in more than sixty pharmaceutical products. During this time, the medicine has unconditionally proven its effectiveness and safety.

And the beginning was made in the early 50s, when Chlorhexidine bigluconate was synthesized in Manchester, at the Royal Chemical Company, which was developing antimalarial drugs. Already in 1954, the new medicine went on sale as a local antiseptic and disinfectant.

Only more than 20 years later, Chlorhexidine began to be used as a topical oral rinse. It turned out that the drug can prevent the development of periodontal disease. Chlorhexidine still holds its position as an anti-periodontal agent today.

A little later, antiseptics began to be included in lubricants, detergents, toothpastes, and even clothing inserts. In 2012, an antithrombogenic catheter was first introduced, which contained Chlorhexidine both externally and internally.

It seems that the story does not end there - this antiseptic still has many new dosage forms and methods of use ahead. After all, you can’t look for such a station wagon! How does the magic drug work? It's time to get into the details.

Mechanism of action of Chlorhexidine

Chlorhexidine bigluconate - this salt is used as an antiseptic - affects microorganisms differently, and this depends on the type of microbes.

The positively charged Chlorhexidine molecule binds to the bacterial cell wall, which has a negative charge. As a result, destabilization and damage to the cell wall occurs. Interestingly, this process only takes about 20 seconds.

However, the role of the antiseptic does not end there. The drug penetrates the cell and attacks the internal cytoplasmic membrane of the bacterium, as a result of which the contents simply flow into the cytoplasm. The cell dies. High concentrations of chlorhexidine digluconate may cause hardening or congealing of the cytoplasm.

The effect of the drug on pathogenic and opportunistic fungi is very similar to the effect on bacteria. By destroying the cell wall, the antiseptic penetrates the cytoplasmic membrane of the fungus and irrevocably destroys the cell.

Biofilm is a complex collection of microorganisms growing on a solid organic (such as dental plaque) or inorganic surface. Biofilms are characterized by structural heterogeneity, genetic diversity, and complex interactions within the conglomerate.

The matrix protects the cells within it, which makes biofilm microorganisms particularly resistant to antibacterial drugs. Most antiseptics are unable to act within the complex structure of the biofilm. Chlorhexidine broke out from the orderly row of powerless relatives and proved its exceptional abilities. The drug can prevent the adhesion (sticking) of microorganisms to a solid surface, as a result of which the growth and development of biofilm stops.

Unlike many antiseptics, Chlorhexidine solution demonstrates high effectiveness against other microbes, for example, bacterial spores and protozoa. It is assumed that it also acts against viruses covered with an additional shell: herpes simplex virus, HIV, cytomegalovirus, influenza virus. Non-enveloped viruses are resistant to Chlorhexidine. These include ARVI pathogens rotavirus, adenovirus and enteroviruses.

Topical chlorhexidine: the hard work of an antiseptic

When applied externally and locally, Chlorhexidine solution forms complexes with proteins of the upper layer of the epidermis or mucous membranes.

When rinsing the mouth, the drug binds to the proteins of the mucous membrane and the surface of the teeth, after which it is slowly released over a long period of time. Imagine that the antimicrobial activity of an antiseptic lasts for two days! As a result of a long-term antiseptic effect, the number of bacteria in the oral cavity is significantly reduced, which in turn prevents plaque.

Due to its ability to “stick” to soft and hard surfaces and release over a long period of time, Chlorhexidine has become the gold standard in dentistry.

Pharmacokinetic properties

Studies confirm that after rinsing with Chlorhexidine solution, about 30% of the active ingredient is retained in the oral cavity.

The drug is intended exclusively for external and local use. However, if you accidentally swallowed a small amount of antiseptic, you should not call an ambulance and prepare for the worst. The drug is practically not absorbed from the gastrointestinal tract. A person who drinks 300 mg of Chlorhexidine - this is almost 300 ml of a solution that is sold in pharmacies - in the blood plasma after half an hour contains only 0.206 mcg / g of the active substance.

Let us add that it is almost impossible for a person of sober mind and clear memory to take 300 ml of antiseptic on the chest. If for some reason force majeure does occur, nothing bad will happen. Over the next 12 hours, the antiseptic will be completely eliminated from the body.

Activity spectrum

So, let's list the microorganisms that cannot resist the action of the drug. Sensitive microbes include:

  • gram-positive microorganisms, including various strains of staphylococcus and streptococcus. The bactericidal effect against gram-positive microorganisms is achieved when exposed to a Chlorhexidine solution at a concentration of less than 1 mg/liter;
  • gram-negative microorganisms: Escherichia coli and Haemophilus influenzae, Klebsiella, Legionella, Pseudomonas, Proteus, Enterobacteriaceae, Salmonella, Moraxella and others. The drug is more active against gram-positive microorganisms than against gram-negative ones. The antiseptic concentration sufficient for an antibacterial effect when contaminated with gram-negative bacteria must be at least 73 μg/ml;
  • mushrooms;
  • enveloped viruses.

The peculiarities of the drug’s action in relation to herpes simplex viruses, HIV, and cytomegalovirus are still being studied.

The drug retains antiseptic properties, although less pronounced, in direct contact with biological fluids, for example, blood or pus. This ability distinguishes Chlorhexidine from most other antiseptics.

Chlorhexidine: use of antiseptic

The scope of Chlorhexidine is not limited to pharmaceuticals. Antiseptic is part of many disinfectants - solutions for treating skin and hands. The cosmetics industry cannot do without the drug. As an antibacterial agent, it is added to toothpastes, deodorants, and antiperspirants. The antiseptic is also included in creams for problem skin, which once again proves the effectiveness of Chlorhexidine as a remedy for acne.

In pharmaceuticals, solutions of Chlorhexidine are used in a concentration of 0.05%, less often - 0.02% as:

  • preservative in eye drops;
  • active ingredient in dosage forms for local and external use, as well as mouth and throat rinses, suppositories, ointments and solutions.

Chlorhexidine in dentistry: indications

Chlorhexidine digluconate is included in mouth rinse solutions. The main indication of an antiseptic is the treatment and prevention of gingivitis.

Let us remember that gingivitis is an inflammatory disease of the gums, which occurs due to the accumulation of microbial plaque on the teeth and is characterized by redness and swelling of the gums. If left untreated in time, the disease can lead to a complication - periodontitis, which leads to the destruction of the alveolar processes.

Patients who are simultaneously diagnosed with both periodontitis and gingivitis are a special category of dental patients that require complex treatment. In such cases, Chlorhexidine is only one of the drugs in combination therapy, and not the main one.

The antiseptic is also used to treat inflammatory disease of the oral mucosa - stomatitis, including aphthous. Chlorhexidine rinses are often prescribed to prevent infection after tooth extraction and other dental procedures.

Among the indications for rinsing, one cannot fail to note the prevention of dental plaque. Possessing a pronounced antibacterial effect, the drug effectively prevents the formation of plaque and tartar on teeth.

Rules for using Chlorhexidine dental solution

How to properly rinse your mouth with Chlorhexidine? So, the procedure is most effective if it is carried out immediately after preventive teeth cleaning. The antiseptic should be applied twice a day - morning and evening - for 30 seconds. The usual dose is 15 ml of undiluted rinse solution.

Immediately after using Chlorhexidine, you should not drink water, brush your teeth or eat breakfast (lunch or dinner) - you will simply wash off the antiseptic. Be patient for 10–15 minutes, and then safely proceed to normal life.

And one last thing. Despite the safety of the medicine, you should still not drink it. When rinsing, make every effort to ensure that the antiseptic does not enter the gastrointestinal tract.

Mouth rinses: an unsightly side effect

One of the most unpleasant side effects of Chlorhexidine digluconate mouthwash is staining the surface of the teeth, dentures, mouth, and dorsum of the tongue.

It is worth noting that such a manifestation of antiseptic does not await all patients. Clinical trials have shown that the likelihood of any noticeable staining is 56%. Moreover, in 15% of people, the discoloration of teeth and tongue will be quite pronounced. Unfortunately, the color scheme in which tooth enamel and the oral cavity are painted does not leave any reason for much optimism. If you fall into the sensitive 15% group, your teeth will likely turn dark brown to black.

Against the background of such information, the possibility of removing stains left by Chlorhexidine using professional methods looks very comforting. The likelihood and intensity of staining increases when interacting with the dyes of tea or coffee.

Recently, manufacturers have begun to produce rinses with Chlorhexidine, which contain an additional component that reduces the risk of staining oral surfaces. Chelated zinc has this effect.

Unlikely but Possible: Other Side Effects of Chlorhexidine Rinse

Other adverse events after using Chlorhexidine oral solution are quite rare. These include:

  • changes in taste sensations, the appearance of a bitter taste;
  • short-term burning sensation;
  • numbness, dryness or soreness of the mucous membranes of the mouth and tongue;
  • increased gum bleeding after a light massage;
  • transient toothache, sore gums, or general discomfort and increased sensitivity during the treatment of periodontitis (in 50.7% of patients versus 41.4% when using a placebo drug).

Chlorhexidine in otorhinolaryngology: indications and rules of use

The activity of Chlorhexidine against most gram-positive bacteria and viruses gives grounds for using an antiseptic as a solution for gargling.

Let us recall that most tonsillitis (inflammatory diseases of the tonsils) and pharyngitis (inflammation of the pharyngeal mucosa) are associated with streptococci and viruses and much less often with staphylococci.

For gargling, use 0.02% and 0.05% Chlorhexidine solution. Unfortunately, it is not yet possible to find a special form of the drug for gargling in Russian pharmacies. However, the most common Chlorhexidine for external use, which is easy to buy, is perfect for use in ENT practice.

To gargle, you will need about 20 ml of 0.02% or 10-15 ml of 0.05% antiseptic solution, which must be held in the mouth for at least 45 seconds. After the procedure, you should not drink, eat or brush your teeth for about 20–30 minutes.

The optimal frequency of rinsing with Chlorhexidine is three times a day. If desired, the number of procedures can be increased. The duration of treatment is 5–10 days or more, as long as the need exists. The positive aspects of treating throat with Chlorhexidine include high efficiency, safety and cost-effectiveness.

What is not found in the instructions: Chlorhexidine for inhalation

The use of Chlorhexidine as a solution for inhalation is also very promising, although this indication is not mentioned in the instructions for the drug. The antiseptic can be used in nebulizers. Fine particles of Chlorhexidine, entering the lower respiratory tract, are an excellent prevention of bronchitis and pneumonia - pneumonia. In addition, inhalations with Chlorhexidine can be used as part of a complex treatment of laryngitis (inflammation of the vocal cords), tonsillitis, and tracheitis.

The frequency of procedures, as well as the duration of treatment, can be practically unlimited - the drug is so safe.

Is it worth using Chlorhexidine in the nose?

Wide antiseptic capabilities and popular love give rise to new questions. A favorite medicine that has helped with sore throat and pneumonia, thrush and stomatitis, diaper rash and burns, in the hope of healing from new diseases, they are trying to drip into the ears and nose. Is it possible and beneficial to use Chlorhexidine solution as nasal or ear drops?

Unfortunately, the answer to this question is likely to be negative. No, of course, an antiseptic is unlikely to have a negative effect. But you shouldn’t expect anything positive either. Despite the activity of Chlorhexidine against many viruses that cause sinusitis, its effectiveness as nasal drops tends to zero. The same applies to otitis media. Therefore, do not waste your time and energy, and save the antiseptic for the future - it will definitely come in handy.

Gel with Chlorhexidine: indications

Recently, another dosage form with Chlorhexidine has appeared on the pharmaceutical market - gel. The drug contains 0.5 g of active substance per 100 g of gel.

On the Russian pharmaceutical market, this product is sold under the name Hexicon and is produced by the German company STADA Arzneimittel.

An amazing property of the drug is its versatility. Hexicon is used for both local and external use. The gel is prescribed:

The drug is indicated for use in gingivitis, stomatitis (including severe aphthous forms), and periodontitis. Unlike mouthwash, dental gel is applied directly to the affected areas. Thanks to this, the potential for Chlorhexidine to affect tooth enamel is significantly less, and, therefore, the likelihood of a side effect in the form of tooth staining is also reduced;

The local drug is used for vulvitis - an infectious inflammatory process of the vulva;

Hexicon gel is prescribed as part of complex therapy for balanitis and balanoposthitis - inflammation of the glans and foreskin of the penis;

The gel form is very convenient for use in dermatological practice: the thick base allows the antiseptic to be absorbed and act for a long time. Hexicon gel is used to treat pyoderma, felon, impetigo, and dermatitis. In addition, the drug helps with diaper rash in adults and children.

Hypersensitivity to antiseptics

When using Chlorhexidine solutions for topical use, there is a possibility of an individual reaction, which can manifest as contact dermatitis, itching, blistering, urticaria, and shortness of breath. In severe cases, there is a hypothetical possibility of anaphylactic shock in sensitized (sensitive) patients.

A study of a wide range of volunteers using a patch test (skin applications of the allergen) showed a positive reaction to Chlorhexidine bigluconate in more than 2% of people. According to researchers, in patients with eczema this figure may exceed 5%.

Chlorhexidine during pregnancy and lactation

Chlorhexidine belongs to category B drugs, the local effect of which when used during pregnancy has not been studied. However, animal studies of the topical solution showed that Chlorhexidine at a concentration of 300 mg per kilogram of body weight per day had no adverse effects on the fetus.

However, given the lack of studies on pregnant women, this antiseptic is used for rinsing only in extreme cases, when the benefit to the mother is potentially greater than the harm to the child.

There is also no data on the penetration of the drug into breast milk during mouth rinsing. In such cases, experts recommend caution when using antiseptics during breastfeeding, giving preference to products with proven safety.

As for the external solution and vaginal suppositories, there are practically no restrictions on their use.

Chlorhexidine rinsing in pediatric practice

Despite the widespread use of Chlorhexidine, the effect of the drug in pediatrics has not been studied. Based on this, it is not recommended to use an antiseptic for rinsing the mouth and throat for children under 18 years of age. We emphasize that this limitation applies only to use in ENT practice and dentistry. External forms of antiseptic are prescribed to children of any age.

External use

Solutions of Chlorhexidine bigluconate 0.05% can be preferred when treating wounds, cuts, burns, minor scratches and other troubles accompanied by a violation of the integrity of the skin.

Washing with Chlorhexidine is not only effective, but also absolutely painless, unlike alcohol solutions and even hydrogen peroxide.

Chlorhexidine and iodine solution: incompatible?

Chlorhexidine's closest competitor is another antiseptic loved by Russian citizens - iodine solution. It can be said that these two drugs have a very tense relationship. And that's why.

When both medications are applied simultaneously to the skin or mucous membranes, there is a risk of developing dermatitis, an acute inflammatory skin disease. Therefore, doctors do not recommend using Chlorexidine together with iodine preparations, not only in dermatology, but also in dentistry, gynecology and surgery.

For the average patient, who is not particularly versed in the intricacies of pharmaceuticals, sometimes it is not even known that a particular drug contains iodine. Therefore, let's list the main medications that should not be used together with Chlorhexidine:

Iodine preparations in ENT practice

  • Lugol's solution is a preparation for topical use based on potassium iodide);
  • Lugs - spray for irrigation of the throat and oral mucosa;
  • Yox is a gargle and spray for the throat and mouth.

Iodine preparations in dermatology and gynecology

  • povidone-iodine (trade names Betadine, Betadine, Vocadine) - solutions for external use, ointments, vaginal suppositories.

So what should you choose?

A comparative description of the effectiveness of the two most famous Russian (and not only) antiseptics was carried out in a full-scale clinical trial involving 850 volunteers. All patients needed the drug to prevent infection of the postoperative wound. The result of the study eloquently confirmed the advantage of Chlorhexidine: the infection rate was significantly lower in the Chlorhexidine bigluconate solution group and was 9.5% versus 16.1% in the Iodine group.

In addition, Iodine is toxic with long-term use, and the likelihood of toxicity or sensitization (sensitivity) to Chlorhexidine is very low. The advantages of the latter include effectiveness in contact with biological fluids, which is not inherent in many other antiseptics. Thus, blood, pus or other organic substances are able to oxidize and bind iodine, as a result of which the iodine solution is inactivated.

In addition, there is another undoubted advantage of Chlorhexidine, which is very valuable when using antiseptics in medical institutions - low price. Chlorhexidine costs 4–5 times less than an alcohol solution of Iodine!

Based on these facts, experts have come to the unequivocal conclusion that Chlorhexidine is a safer, cheaper and more effective alternative to Iodine solution.

Chlorhexidine in gynecology: indications for use and release forms

The pronounced antiseptic properties of Chlorhexidine and excellent tolerability allow the drug to be widely used in obstetrics and gynecology.

Among the indications for use:

  • colpitis of any etiology, including trichomonas;
  • candidiasis or thrush;
  • sanitation of the genital tract during diagnostic procedures or surgical interventions;
  • prevention of sexually transmitted infections.

There are two main forms of release of the drug, which are intended for use in gynecological practice. These include:

  • aqueous solution at a concentration of 0.05%;
  • vaginal suppositories containing 16 mg of active ingredient;
  • gel for vaginal use.

Let's look at each form in more detail.

Douching solution with Chlorhexidine

An aqueous solution of Chlorhexidine is used in medical institutions for antiseptic treatment of the genital tract. Some doctors prescribe douching with an antiseptic at home.

A solution of Chlorhexidine at a concentration of 0.05%, which is usually sold in pharmacies, is used for douching in its pure form. This means that the drug is completely ready for use - it does not need to be further diluted with water or any other solvents.

There is a special form of release of the drug for douching, which differs from the usual additional vaginal nozzle. If you don’t find such a bottle on sale, it doesn’t matter. It can be successfully replaced by a regular syringe with a solid nozzle.

Douching rules

If you have Chlorhexidine and a device for the treatment procedure in your first aid kit, you can start douching. To do this, you should first treat the inside of the syringe with boiled hot water and sterilize it, that is, boil the attachment to the bottle or syringe for several minutes (they must be removable).

One procedure will require 5–10 ml of solution. By the way, you should not heat the douching solution - the chemical and pharmacological properties of the antiseptic may change with increasing temperature.

The medicine is inserted into the vagina for 2-3 minutes. The procedure is carried out 5–7 times, once a day.

Suppositories with chlorhexidine: release forms and indications

Vaginal suppositories with an antiseptic are also quite popular in domestic medical practice. They are produced in one release form with an active substance content of 0.008 g per suppository.

Among the indications for the use of suppositories with Chlorhexidine:

  • childhood vulvovaginitis, regardless of etiology;
  • bacterial vaginosis;
  • colpitis, including in pregnant women;
  • prevention of sexually transmitted diseases.

The drug is prescribed 1-2 times a day in the morning and evening for 5-7 days. If necessary, treatment can be extended to 14–20 days or more.

Suppositories are usually well tolerated and rarely cause discomfort, such as itching or burning.

A distinctive feature is the high safety profile, which allows the drug to be used both in pediatric practice and in pregnant women.

Chlorhexidine treatment and gardenerellosis: where is the truth?

Recently, information about the connection between douching with Chlorhexidine and the development of gardenerellosis has begun to appear more and more often in Russian-language sources. Let's try to figure out whether an antiseptic could be the cause of the disease.

First of all, let's remember what gardenerellosis is. Gardnerella vaginalis - Gardenerella is an opportunistic microorganism that lives in the vagina of healthy women, usually without causing any harm.

However, when the balance of microflora changes, which can occur due to decreased immunity, taking antibacterial or local antiseptic drugs, gardenerella can begin to multiply. The natural result is the development of bacterial vaginosis, manifested by copious discharge, itching and other troubles.

What does Chlorhexidine have to do with it? It's simple: regular vaginal douching is still not the most beneficial procedure for the microflora. Especially douching with an antiseptic. With long-term therapy, the pH of the environment changes, as well as the qualitative and quantitative composition of bacteria. Thus, favorable conditions for bacterial vaginosis have been created. If they are joined by immune deficiency, for example, against the background of ARVI, the development of gardenerellosis or candidiasis (which has the same causes) will not surprise anyone.

The conclusion is obvious: Chlorhexidine cannot be considered the direct culprit of bacterial vaginosis. But the drug can give impetus to the development of gardenerellosis.

To avoid complications, women with a reduced immune response are better treated with suppositories or vaginal gel with Chlorhexidine. These dosage forms, unlike douching, do not disrupt bacterial harmony in the vagina.

Fighting sexually transmitted infections: cheap and effective

The effectiveness of Chlorhexidine solution against sexually transmitted infections cannot be ignored. Gram-positive and gram-negative bacteria, which are responsible for the very diseases that people prefer not to talk about out loud, are sensitive to antiseptics. Among these microorganisms:

  • Treponema spp., including pale spirochete - the causative agent of syphilis;
  • Neisseria gonorrhoeae, the causative agent of gonorrhea;
  • Trichomonas spp., including the culprit of trichomoniasis;
  • Chlamydia spp., including the causative agent of urogenital chlamydia;
  • Ureaplasma spp., including the causative agent of ureaplasmosis.

Let us also recall the activity of Chlorhexidine against the genital herpes virus (Herpes simplex type II) and HIV.

The main condition for the effectiveness of an antiseptic is timely application. The drug protects against infection if used no later than two hours after unprotected sexual intercourse. The external genitalia, inner thighs, and pubis are subject to treatment. In addition, it is necessary to administer the antiseptic urethrally to men in an amount of 2–3 ml and vaginally to women, the average application volume is 5–10 ml. Processing time is 2–3 minutes.

Attention: medicine and small children!

We have already mentioned the high safety of the drug, including accidental ingestion. However, if we are talking about a small child, you should be careful and keep the medicine out of the reach of children.

If you accidentally ingest a mouthwash containing Chlorhexidine, you may develop signs of poisoning. So, if a child weighing 10 kilograms (about 1 year old) drinks 30–60 ml of mouthwash, the following may occur:

In such cases, parents can help the baby by rinsing the stomach with a weak solution of potassium permanganate or, for example, chamomile infusion.

Chlorhexidine analogs

Among the analogues of Chlorhexidine, one can single out one single drug produced by the German company Stad - Hexicon, which is available in various dosage forms. It is worth noting that the price of Hexicon is significantly higher than the cost of “our” antiseptic.

In conclusion, we add that both Chlorhexidine and Hexicon are over-the-counter drugs. Their popularity and effectiveness are so great that they are invariably included in home medicine cabinets. By the way, check if your Chlorhexidine is running out?

The article above and comments written by readers are for informational purposes only and do not encourage self-medication. Consult a specialist regarding your own symptoms and illnesses. When taking any medicine, you should always use the instructions that come with the medicine and your doctor's advice as a guide.

In order not to miss new publications on the site, it is possible to receive them by email. Subscribe.

Do you want to get rid of your nose, throat, lung and cold diseases? Then be sure to check it out here.

It is also worth paying attention to other medications:

Print: menu - print or CTRL + P.

Join, speak out and discuss. Your opinion may be very important to many readers!

Copying materials without written permission and an open link is prohibited.

Source: http://cc-t1.ru/preparaty/hlorgeksidin.html

Chlorhexidine - instructions, use, reviews

Chlorhexidine (lat. Chlorhexidinum) is an antiseptic for topical use. In Russia it is produced mainly in the form of bigluconate.

Available in the form of solutions, aerosols, vaginal suppositories, external gels and creams. The drug is effective against a wide range of gram-negative and gram-positive bacteria, fungi, and some viruses. Has a bactericidal effect on pathogens of sexually transmitted diseases.

Indicated for the purpose of preventing STDs, for purulent-inflammatory processes of the skin or mucous membranes, for treating surgeon's hands, and sterilizing medical instruments. After application to the body, chlorhexidine continues to remain active for several hours.

Story

Chlorhexidine was synthesized in 1947. The formula for the drug was randomly developed by English scientists during the search for new antimalarial drugs. It turned out that the substance with experimental number “10 040” has a high affinity for the cell walls of bacteria and quickly causes their destruction. The new compound was patented as an antiseptic.

In 1954, the English pharmaceutical company Imperial Chemical Industries released the first medicinal solution of chlorhexidine bigluconate under the trade name Gibitan. Initially, the product was intended for disinfection of skin and wound surfaces, but after 3 years the range of its indications was significantly expanded. "Gibitan" began to be actively used in gynecology, urology, otolaryngology and ophthalmology.

In 1959, chlorhexidine was proposed for use in the treatment of the oral cavity, which led to its spread in dental practice.

Over time, the antiseptic began to find more and more widespread use. In the 80s it was allowed to be added to cosmetic products and lubricants. In 1993, chlorhexidine wipes were introduced to the US market for both household and medical use. In 2012, the FDA approved the release of chlorhexidine-impregnated catheters and implants.

Properties

International nonproprietary name: chlorhexidine.

Chemical name according to IUPAC nomenclature: N,N"-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecanediimidamide

Molecular weight: 505.5

Chlorhexidine is a white crystalline powder, highly soluble in water. Aqueous solutions have an alkaline reaction. Melting point -ºС. According to the chemical structure, the compound belongs to biguanide derivatives.

Clinical data

The therapeutic activity and safety of chlorhexidine have been studied in dozens of international clinical studies. The drug has confirmed its high effectiveness against a wide range of bacteria, fungi and protozoan microorganisms.

A large trial in 1988 (Garibaldi, R. A) compared the antibacterial properties of chlorhexidine and povidone iodine. 700 patients who were scheduled for surgery took part in the experiment. Immediately before the operation, the volunteers took a shower with one of the antiseptics. Laboratory test data showed that chlorhexidine reduced the number of microbial colonies on the skin by 9-9.5 times, while povidone-iodine only reduced the number of microbial colonies on the skin by 1.5-2 times.

In the US, the National Institute of Children's Health assessed the effect of treating newborns with chlorhexidine a few hours after birth on infant mortality rates. The study was conducted in Nepal, where the percentage of births at home is high. Outreach was carried out among 413 local communities, whose members were advised to treat infants with a 4% chlorhexidine solution. Over 4 years of observation, the frequency of child deaths in the studied populations decreased by 30%.

In 1999, the University of Oslo studied the ability of an antiseptic to reduce the transmission of pathogenic streptococci from mother to child during childbirth. A 0.2% solution of the drug was administered intravaginally to infected women during contractions. The results showed that the incidence of illness in infants was reduced by an average of 20%. No adverse reactions associated with exposure to chlorhexidine were observed in children.

A blinded, placebo-controlled study on the effect of the drug on stomatitis was conducted at the University of Kentucky in 1988. In patients who agreed to use chlorhexidine rinses, the authors noted a decrease in ulceration of the oral mucosa, a decrease in colonies of streptococci and yeast fungi.

In all trials, doctors paid attention to the good safety profile of the drug. In rare cases, irritation to the eyes and skin was noted. It was possible to eliminate side effects after reducing the concentration of antiseptic solutions.

Toxicity Information

The toxicity of chlorhexidine was studied in laboratory experiments on white mice. A 0.5% solution was administered to animals subcutaneously, intravenously and intraperitoneally. The drug has been proven to lack mutagenic, teratogenic and embryotoxic effects. A weak inhibitory effect on the functions of the reproductive organs was noted.

Composition, release forms, packaging

The following forms of chlorhexidine are available on the Russian pharmaceutical market:

  • Aqueous solutions with a concentration of the active substance of 0.05; 0.1; 0.15; 0.2; 0.5; 1; 4, 5 and 20%. The drug is packaged in plastic vials, bottles or aerosol cans.
  • Alcohol solutions with an active substance concentration of 0.5 or 0.8%. This form is sold in ml bottles.
  • Vaginal suppositories containing 16 and 8 mg of active ingredient. They are packaged in plastic blisters and then in cardboard packs of 5 or 10 pieces.
  • 0.5% gel for external use. Produced in linear tubes.
  • 1% cream for external use. Available in 50 g tubes.
  • 1% emulsion (in glycerin) for external use. Packaged in 200 ml bottles.

Mechanism of action

In a physiological environment, chlorhexidine dissociates to form active cations that interact with negatively charged bacterial cell walls. Conditions for binding are most favorable at pH values ​​from 5 to 8.

At low concentrations, the drug blocks the transport of ions through the membranes of pathogenic cells, which leads to the development of a bacteriostatic effect. At concentrations greater than 0.01%, cell walls rupture, resulting in rapid death of microbes.

In the presence of blood and pus, the effectiveness of the drug decreases slightly.

Spectrum of antimicrobial activity

Chlorhexidine is active against:

  • gram-positive bacteria (streptococci, staphylococci, clostridia),
  • gram-negative bacteria (neisseria, chlamydia, ureaplasma, bacteroides, enterobacteria),
  • yeast and yeast-like fungi,
  • dermatophytes,
  • protozoa (Trichomonas, chlamydia, etc.),
  • some viruses (herpes virus, influenza A virus).

The drug does not affect lactobacilli, acid-fast strains of bacteria and fungal spores.

Fungicidal properties appear at a concentration of chlorhexidine of more than 0.05%, virucidal properties - at a concentration of more than 1%.

Metabolism and excretion

The drug is practically not absorbed in the digestive tract. If 300 mg of chlorhexidine is accidentally ingested, the maximum plasma concentration is reached after 30 minutes. and does not exceed 0.3 µg/l. After 12 hours the drug is not detected in the blood.

The antiseptic binds well to the skin and mucous membranes. Absorption of the drug when applied topically was studied in experiments with rhesus monkeys. With regular use of an 8% solution for 3 months. trace amounts of chlorhexidine (less than 20 µg/kg) were detected in the kidneys, liver and adipose tissue of animals. The drug was not present in blood samples.

There are no data on the metabolism of chlorhexidine. The antiseptic is excreted from the body unchanged.

Indications

Aqueous solutions of chlorhexidine with a concentration of less than 0.2% are prescribed for the purpose of:

  • prevention of sexually transmitted diseases,
  • disinfection of skin (for cracks, abrasions),
  • treatment of purulent wounds, burns,
  • treatment of bacterial and fungal infections of the skin or mucous membranes,
  • treatment of inflammatory diseases of the oral cavity (gingivitis, stomatitis, alveolitis, etc.).

Indications for the use of 0.5% aqueous and alcohol solutions are:

  • disinfection of wounds, burns, cracks in the skin,
  • disinfection of medical instruments, devices and equipment for which thermal sterilization is impossible.

A 1% solution of the drug is indicated:

  • for disinfection of thermometers, instruments and equipment,
  • for treating the surgeon's hands and the surgical field,
  • for disinfection of postoperative wounds and burns.

Solutions with higher concentrations (4, 5 and 20%) are intended for the preparation of 0.01-1% aqueous, alcoholic or glycerin solutions of chlorhexidine.

The reasons for prescribing vaginal suppositories are:

  • prevention of STDs,
  • prevention of infectious complications in obstetric or gynecological practice (before abortion, childbirth, installation of an intrauterine device, etc.),
  • therapy of vaginosis, colpitis.

Gel and cream with chlorhexidine are used:

  • in dermatology - for the treatment of wounds, diaper rash, impetigo, pyoderma,
  • in urology and gynecology - for vulvovaginitis, balanoposthitis, balanitis,
  • in dentistry - in the treatment of gingivitis, periodontitis, stomatitis, aphthae, etc.

Contraindications

The product is not recommended for the following conditions:

  • dermatitis,
  • hypersensitivity to chlorhexidine.
It is forbidden to use an antiseptic to wash eyes and cavities.

Chlorhexidine should be used with caution in childhood.

Use during pregnancy or lactation

When used cutaneously, chlorhexidine preparations are not contraindicated in pregnant and lactating women.

Intravaginal forms during pregnancy and lactation should be used at the discretion of the physician after a careful assessment of their benefits to the woman and the risks to the fetus or child.

Impact on the ability to drive vehicles and other complex mechanisms

Therapy with chlorhexidine does not affect the speed of psychomotor reactions, so the drug can be prescribed to persons engaged in potentially hazardous activities.

Methods of application

Chlorhexidine solutions are applied to the skin, mucous membranes of the genitourinary organs or mouth for 1-3 minutes. by irrigation or on cotton swabs.

To prevent STDs, the solution is injected using a nozzle on the bottle: for men - into the urethra, for women - into the vagina for 2-3 minutes. After the procedure, you should not urinate for 2 hours. At the same time, it is recommended to treat the inner thighs, pubis and genitals.

To treat urethritis and uroprostatitis, the solution is injected into the urethra up to 2 times a day for 10 days. The procedures are repeated every other day.

Treatment of medical instruments and devices is carried out by wiping the surfaces with a sponge soaked in the preparation or by soaking.

The surgical field is treated twice with an interval of 2 minutes.

The surgeon's hands should be washed with soap and dry thoroughly before applying chlorhexidine.

Suppositories are administered intravaginally in the supine position. To prevent STDs, it is recommended to use 1 suppository no later than 2 hours after sexual intercourse. In other cases, 1 suppository is administered 1-2 times a day for 1-3 weeks.

Gel and cream are applied to the affected areas up to 3 times a day. The duration of treatment is determined individually, taking into account the clinical picture of the disease.

Side effects

When using chlorhexidine, the following may occur:

  • allergic reactions,
  • dermatitis,
  • itching and dry skin,
  • feeling of stickiness on the skin (during the first 3-5 minutes after application),
  • discoloration of the skin areas treated with the drug,
  • increased skin sensitivity to UV radiation (photosensitization),
  • staining of teeth, taste disturbances (only in the treatment of gingivitis),
  • itching and burning in the vagina (in case of using suppositories).

special instructions

If you accidentally use chlorhexidine orally, you should rinse your stomach and take the adsorbent. If necessary, the patient should receive symptomatic therapy.

Solutions with a concentration of more than 0.2% should not be applied to wounds and mucous membranes.

If the product gets into your eyes, you should quickly rinse them under running water, then drip a solution of sodium sulfacyl. If inflammation persists, you should consult a doctor.

Chlorhexidine is flammable, so it is recommended to keep its preparations away from heating devices.

The use of suppositories is acceptable during menstruation.

Bleaching fabrics that have previously been exposed to chlorhexidine may result in brown stains.

Interaction with other drugs

Chlorhexidine is not compatible with soaps and detergents containing sodium lauryl sulfate, saponins or sodium carboxymethylcellulose. Before using the drug, any remaining detergent must be thoroughly rinsed off.

The activity of the antiseptic is inhibited in the presence of iodine and enhanced in the presence of ethyl alcohol.

The use of hard water reduces the bactericidal effects of chlorhexidine.

Under the influence of alkalis or when heated, the drug decomposes to form 4-chloroaniline, which has carcinogenic properties.

The antiseptic can be combined with products containing benzalkonium chloride or cetrimonium bromide.

Vacation conditions

All dosage forms are available without a prescription. 20% concentrated solutions are supplied only to medical institutions.

Storage

At a temperature not higher than 25ºС. Keep away from open flame.

Best before date

For solutions - 2-3 years (depending on the manufacturer).

For candles - 2 years.

For gel and cream - 2-3 years.

Application in different countries

Chlorhexidine is approved for medical use in more than 50 countries.

The antiseptic is available in the form of independent dosage forms, and is also included in various combination products:

  • antibacterial ointments, solutions,
  • lozenges for resorption,
  • toothpastes,
  • mouth rinses,
  • shampoos.

In European countries, the acetate salt of the drug is more common, which in its pharmacological properties is completely identical to bigluconate.

In 2013, chlorhexidine was included in the WHO List of Essential Medicines.

Review of manufacturers

In the Russian Federation, chlorhexidine preparations from several dozen manufacturers are sold. The main market share belongs to domestic enterprises. Various companies produce antiseptics under the names “Chlorhexidine”, “Chlorhexidine bigluconate” or under their own patented names. Among dosage forms, solutions with a concentration of 0.05-0.15% predominate.

Some chlorhexidine preparations and their manufacturers:

SPC "Biogen" (Russia)

CJSC Central European Pharmaceutical Company (Russia)

Analogs

The antiseptic Miramistin (lat. Myramistin) is closest in its properties to chlorhexidine. The drug was developed by Soviet scientists in the 1980s. within the framework of the “Space Biotechnologies” program. At the moment, the product is produced by the Russian company CJSC Infamed and the Ukrainian company CJSC Darnitsa. Products are sold in the countries of the former USSR.

Compared to chlorhexidine, Miramistin has a wider spectrum of antimicrobial activity.

The following are sensitive to the drug:

  • gram-positive and gram-negative bacteria (including strains resistant to antibiotics),
  • protozoa (chlamydia, trichomonas, etc.),
  • ascomycetes,
  • yeast and yeast-like fungi,
  • dermatophytes,
  • influenza viruses, measles, herpes, adenoviruses, coronoviruses.

Experiments also demonstrated the ability of Miramistin to reduce the activity of the human immunodeficiency virus (HIV).

Other advantages of the analogue include:

  • lack of local irritation and allergenic effects,
  • the ability to activate local immunity of the skin and mucous membranes,
  • the presence of anti-inflammatory and regenerating properties,
  • absence of negative reactions in the treatment of dental diseases (patients do not experience staining of teeth or changes in taste sensitivity).

The use of Miramistin is considered preferable in the treatment of the oral cavity, in the treatment of urological and gynecological pathologies and for the prevention of sexually transmitted infections.

At the same time, in laboratory studies it has been proven that chlorhexidine has a higher level of antimicrobial activity against Staphylococcus aureus (St. aureus), Escherichia coli (E. Coli), Pseudomonas aeruginosa (P. Aeruginosa) and fungi of the genus Candida (Candida) . This leads to its more active use for aseptic purposes and in the treatment of wound infections.

In the Republic of Belarus, in addition to Miramistin, its generic, Septomirin, produced by RUE Belmedpreparaty, is widely used.

Thank you for the detailed description of the drug and good health to you all.

Source: http://farmamir.ru/2015/08/xlorgeksidin-instrukciya-primenenie-otzyvy/

Chlorhexidine

Chlorhexidine is a good antiseptic that has a wide range of applications. The drug is a colorless liquid, sometimes with a slightly yellowish tint. It has no smell and is packaged in 100 ml glass containers. The solution is used to disinfect surfaces; it is used in dentistry, cosmetology, for the treatment of ENT diseases, and shoe treatment.

The use of chlorhexidine in dentistry

In dental practice, the use of chlorhexidine bigluconate is considered the most effective for antiseptic treatment of the oral cavity; it has disinfecting properties and is used for the treatment and prevention of diseases. This substance can be used in its pure form; it is included in other preparations for local treatment.

Chlorhexidine is used to treat, relieve exacerbations and prevent the following diseases:

At home, a gel containing the active ingredient chlorhexidine is often used - Elugelle, Metrogyl Denta. It is included in toothpastes – Elgidium and Curaprox. These drugs help reduce gum bleeding, eliminate purulent inflammation, and eliminate unpleasant odor.

After tooth extraction, rinsing is prescribed to prevent the development of inflammation, using a solution in a concentration of 0.5%. Dental surgeons treat their hands with an alcohol solution of chlorhexidine; before surgery, the patient is asked to rinse his mouth with a weak solution to increase sterility when performing dental sanitation.

Chlorhexidine increases the effectiveness of superficial anesthesia; it is used in conjunction with lidocaine, reducing the level of bacteria at the injection site, which prevents the development of infections. Eliminates microbes in areas where teeth are treated to remove tartar and plaque. For root canal treatment, a 2% solution is used.

Chlorhexidine mouth rinse is also prescribed after dental implantation as an antiseptic.

Features of application

Chlorhexidine is a popular and widespread remedy, but its use has a number of features that should be taken into account. These include:

  • Duration of use is limited to no more than 2 weeks. The drug is addictive, which reduces its effectiveness;
  • With prolonged use, the development of dysbacteriosis is possible;
  • The drug can stain tooth enamel brownish; after treatment, teeth must be treated to restore their color;
  • Before use, you should carefully study the instructions for use, dosages, and special instructions.

Attention! The use of the drug may cause allergic reactions - dry mouth, taste disturbances. If such symptoms appear, stop using the drug and consult a specialist.

Instructions for use

The solution can only be used for topical use (for rinsing the mouth, throat). Instructions for use:

  1. The throat is rinsed with water at room temperature.
  2. Take a tablespoon of solution – ml into your mouth and rinse your mouth (throat) thoroughly.
  3. Rinse for 30 seconds, then spit out the product completely.

Rules for using the solution:

  • The product does not require additional rinsing;
  • All hygiene procedures are carried out before rinsing;
  • Before use, clean the mouth and teeth; leftover food and toothpaste will reduce the therapeutic effect of the drug;
  • The product 0.5% is available in a ready-to-use form; it does not need to be diluted with water;
  • After application, you should not eat for 1.5-2 hours;
  • Antiseptics with concentrations greater than 0.5% are not used in direct contact with skin and mucous membranes;
  • During and for two weeks after application, you should not consume food or drinks that are colored.

Rinsing is carried out 2-3 times a day, as recommended by a doctor.

Important! Do not swallow the drug! If the substance gets inside, you must immediately rinse your stomach and take 10 tablets of activated carbon.

Cost of the drug

The cost of the drug depends on a number of factors, which include the manufacturer, the region and the pharmacy chain where the sale is made. The price in a pharmacy per unit varies from 25 to 200 rubles. There is no point in buying colorful packaging, because the composition in them is identical.

Which is better: miramistin or chlorhexidine

Miramistin is an excellent antiseptic that is actively used to combat fungal, viral and bacterial infections, as well as to prevent them. This is a new generation product that appeared not so long ago. The drug has powerful anti-inflammatory properties and reduces the risk of infection. The substance at the heart of this product is miramistin.

Chlorhexidine has similar antiseptic properties, but this drug has been known for a long time and is actively used for the prevention and treatment of many diseases. Currently, there are no drugs among antiseptics that could compete with chlorhexidine. This is an affordable remedy that is in demand not only in medicine, but also in everyday life. The basis of the drug is the substance chlorhexidine.

The spectrum of action of miramistin and chlorhexidine is almost identical, however, the drugs differ somewhat from each other, and not only in the active substance. In particular:

  1. When the bubbles are shaken, Miramistin forms a dense foam that does not settle for a long time. Chlorhexidine produces a loose foam that settles quickly.
  2. Chlorhexidine is preferable to use for external treatment; when it comes into contact with mucous membranes, it causes a noticeable burning sensation. Miramistin does not give such a reaction.
  3. Long-term use of chlorhexiline affects the color of tooth enamel, Miramistin acts more gently, and the color of teeth is preserved.

Advice! You should choose between these two drugs on the advice of a specialist. Only a doctor determines in which cases the use of one or another remedy is preferable.

Use during pregnancy

Many people are interested in the question of whether the drug can be used during pregnancy and breastfeeding. In the instructions for use, there is no such item among the contraindications; when irrigating the oral cavity, the active substance practically does not enter the woman’s blood. Therefore, it can be used by pregnant and lactating women. But it is better to additionally consult a doctor on this issue.

When rinsing, care must be taken to ensure that the drug does not get inside. It is also worth considering some contraindications for use, which include:

  • High sensitivity to the components of the drug;
  • Allergic reactions.

In addition, it must be remembered that the drug causes certain side effects. These include:

  • Taste disturbances;
  • Burning tongue and throat;
  • Swelling of the salivary glands;
  • Skin irritation.

Attention! If chlorhexidine is used to treat oral thrush, treatment is extended for two days after symptoms have resolved. This will remove any remaining germs and prevent the disease from recurring.

Chlorhexidine for ENT diseases

For tonsillitis and other damage to the tonsils, the use of chlorhexidine is an effective and affordable way to get rid of the disease, and the price of the drug is minimal. Most importantly, the product does not cause damage to the inflamed mucous membrane of the throat and nasopharynx. In addition, the drug is non-toxic, which allows it to be used to treat small children and pregnant women.

Chlorhexidine is used for the following purposes:

  • The active substance allows you to wash off and remove bacteria, remove purulent plugs;
  • Remove the contents of ulcers on the throat;
  • Accelerate healing, moisturize mucous membranes;
  • Activate the action of antibiotics to eliminate infection;
  • Create an environment favorable for rapid healing of the throat, preventing further development and proliferation of bacteria.

Chlorhexidine is not used as an independent remedy for ENT diseases; it brings the greatest benefit in combination with antibiotics and antiviral drugs.

How to gargle? Recommendations for treating the throat for sore throat are similar to those for dental diseases. The rules of application are as follows:

  • The first rinses are carried out for seconds; later, if allergic reactions are not observed, the time can be increased to 1 minute;
  • Gargling for children and pregnant women is done with a solution of 0.05% concentration; if it gets into the stomach, induce vomiting and give the child 5-6 tablets of activated carbon;
  • Treatment of sore throat is carried out with this drug for at least a week; it is not recommended to use it for more than two weeks.

Many people are interested in the question of whether it is possible to rinse the nose for rhinitis, sinusitis, and sinusitis. Treatment of the nose for these diseases will eliminate common symptoms. But for diseases such as tonsillitis, bronchitis, pharyngitis, the drug shows high effectiveness.

The rinsing solution should be diluted and act with caution, as it can cause irritation of the mucous membrane. Washing is carried out as follows:

  • Remove mucus with nasal spray;
  • Lightly warm the chlorhexidine solution (concentration – 0.05%);
  • Tilt your head to the side, drip the solution into the nostril on top. He should come out the other side.

Treatment is carried out for 1 week, washing should be done 2 times a day. 15 ml of solution is enough for one procedure.

Advice! To enhance the effect of the antiseptic, it can be combined with a weak solution of alcohol. This is an excellent remedy for removing purulent crusts.

For acne

Chlorhexidine for acne is the best antiseptic for the face. It is able to penetrate into skin cells, staying there for a long time. Even a small concentration of the product works for a long time; its use is simple and does not require time. Even complex problems - rashes, acne - can be treated.

The directions of action of chlorhexidine for the face are as follows:

  • The drug penetrates the pimple and eliminates microbes;
  • It burns out the abscess, cleanses the wound;
  • Removes dead cells and cleanses the skin.

Rules for using the drug to treat acne:

  • The medicine is applied to a cotton pad and distributed over problem areas. If you need to treat individual pimples, you can use cotton swabs;
  • You should not frequently wipe your skin with this product. Despite the harmlessness of the drug, its high concentration in the skin can cause allergies, dryness, the appearance of a new rash or pigmentation;
  • The regularity of using the drug for the skin should be discussed with a dermatologist;
  • It is strictly forbidden to combine the use of chlorhexidine with other antiseptics. You can increase the effectiveness of the drug by combining it with levomikol, salicylic ointment, and alcohol infusions. During treatment, you can use other methods of combating acne - creams, scrubs, peelings.
  • During the period of getting rid of skin problems, you should maintain proper nutrition and avoid eating fatty and sweet foods.

Consumer Reviews

“My doctor recommended chlorhexidine to me. I have always had problem skin, and my habit of touching my face with dirty hands makes the situation worse. I tried the product, especially since the price is more than reasonable. There was an effect, but at the same time I discovered that the oiliness of the skin increased. It is possible that this is an individual reaction. You cannot use it constantly, but you can periodically disinfect the skin. The rest of the time I wash my face with chamomile.”

“I’ve long heard that chlorhexidine is used in dentistry as an antiseptic. My dentist prescribed this product for me as a mouth rinse. Honestly, the taste is just terrible, but it helps. The gums have become noticeably stronger and do not bleed as much. Can be used. But I’m afraid for children to gargle with this product; they don’t understand that it shouldn’t be swallowed, so we only use it for adults.”

“We use the mouthwash as prescribed by the dentist. There is little pleasant, the tongue is numb for some time, bitterness spreads in the mouth. But in terms of effectiveness, it is far ahead compared to the newest drugs! Already the first application gives results. But you shouldn’t give it to children, even though it has no contraindications.”

“Chlorhexidine is a proven remedy for sore throat and dental problems, I know it personally. It is always present in our first aid kit, along with brilliant green, iodine and paracetamol. Not long ago I discovered that it also helps with sore throats. True, the sensation is unpleasant, and my throat is sore. But compared to other home treatment methods, the result is excellent. We will use it, but rarely, it still tastes very nasty.”

More articles on the topic:

Useful article? Add to your bookmarks!

Source: http://infozub.ru/lechenie/xlorgeksidin.htm