1. Introduction
Chlorhexidine is a broad-spectrum antimicrobial agent used in various formulations to prevent and treat infections. It is effective against a wide range of gram-positive and gram-negative bacteria, fungi, and some viruses. Chlorhexidine is commonly used in oral care, wound care, preoperative skin preparation, and catheter care due to its excellent antiseptic properties and sustained action.
2. Indications
- Approved Indications:
- Antiseptic mouthwash for oral hygiene (e.g., gingivitis, periodontitis).
- Preoperative skin disinfection.
- Wound cleansing and prevention of infection in minor cuts or burns.
- Catheter site care.
- Disinfection of surgical instruments.
- Off-Label Uses:
- Vaginal antiseptic for preoperative preparation.
- Prevention of ventilator-associated pneumonia in ICU patients (as an oral rinse).
3. Dosage
- For Oral Hygiene (Mouthwash):
- Rinse with 10–15 mL of a 0.12% or 0.2% solution for 30 seconds, twice daily.
- For Skin Disinfection:
- Apply 2% or 4% solution directly to the skin and leave for the required duration before procedures.
- For Wound Care:
- Use a 0.05% solution to irrigate or clean wounds as needed.
- For Catheter Care:
- Apply a 2% solution using a sterile applicator to the insertion site.
4. Administration
- Oral Rinse: Do not swallow. Avoid eating or drinking for 30 minutes after use for maximum efficacy.
- Topical Solutions: Apply only to external surfaces. Avoid contact with eyes, ears, and mucous membranes unless specified.
- Wound Care: Irrigate the wound gently without excessive pressure.
5. Forms Available
- Mouthwash: 0.12%, 0.2% solutions.
- Topical solution: 2%, 4%.
- Wound irrigation solution: 0.05%.
- Gel: 1%.
- Impregnated dressings and wipes.
6. Side Effects
6.1. Common Side Effects
- Oral irritation or taste alteration (mouthwash).
- Dry mouth.
- Skin dryness or irritation (topical use).
6.2. Less Common Side Effects
- Tooth discolouration (temporary, with prolonged use).
- Burning sensation on the skin or mucosa.
6.3. Rare but Serious Side Effects
- Allergic reactions (e.g., rash, swelling, anaphylaxis).
- Corneal damage if accidentally introduced into the eye.
- Hearing loss with prolonged exposure to the middle ear.
7. Warnings
- Avoid contact with the eyes and ears, as it may cause severe irritation or permanent damage.
- Do not ingest mouthwash formulations.
- Use cautiously in patients with a history of hypersensitivity to chlorhexidine or related compounds.
8. Precautions
- Rinse thoroughly after oral use to prevent staining or taste alteration.
- Avoid use in deep wounds or body cavities due to the risk of tissue irritation.
- Prolonged use may alter oral flora, potentially increasing the risk of fungal infections.
9. Interactions
- Drug-Drug Interactions:
- Sodium lauryl sulfate (found in many toothpastes) may reduce the efficacy of chlorhexidine if used immediately before or after rinsing.
- Avoid concurrent use of other strong antiseptics to prevent additive irritation.
- Drug-Food Interactions:
- Avoid food or beverages for 30 minutes after using chlorhexidine mouthwash to maintain effectiveness.
10. Monitoring Parameters
- Assess for signs of infection improvement in wounds or surgical sites.
- Monitor for any signs of hypersensitivity, such as rash or swelling.
- Evaluate for oral side effects like staining or altered taste if used as a mouthwash.
11. Use in Children
- Approved for use in children over 6 years of age for oral care, with proper supervision to prevent swallowing.
- Topical formulations can be used cautiously in younger children under medical guidance.
12. Use in Pregnancy
- Considered safe for topical and oral use during pregnancy.
- Avoid prolonged or excessive use, especially near mucosal surfaces.
13. Use in Elderly
- No specific adjustments needed. Monitor for skin sensitivity or irritation with repeated topical use.
14. Use in Kidney Disease
- Safe for use, as systemic absorption is minimal.
15. Use in Liver Disease
- No specific adjustments required, as chlorhexidine is not significantly metabolised systemically.
16. Patient Counselling Points
- For mouthwash, advise patients not to swallow and to avoid rinsing with water immediately after use.
- Explain the potential for temporary tooth discolouration and that it can be removed by professional cleaning.
- Inform patients to stop using chlorhexidine and seek medical attention if they experience any signs of an allergic reaction.
- Emphasise that chlorhexidine is for external use only and should not be used in or near the eyes or ears.
- Encourage patients to follow the recommended dosage and duration of use to avoid unnecessary side effects.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Corsodyl | GSK | $8–12 (300 mL, 0.2% mouthwash) |
Hibiclens | Mölnlycke Health Care | $10–15 (237 mL, 4% solution) |
Peridex | 3M | $9–13 (300 mL, 0.12% mouthwash) |
Generic Options | Various | $5–10 (similar formulations) |
18. FAQs (15 Questions)
- What is chlorhexidine used for?
It is used to prevent and treat infections in the mouth, skin, wounds, and surgical areas. - How does chlorhexidine work?
It disrupts bacterial membranes and precipitates cell contents, killing bacteria and other microbes. - Is chlorhexidine safe for long-term use?
Long-term use is safe for specific conditions but may cause side effects like tooth staining or altered oral flora. - Can chlorhexidine cause allergic reactions?
Yes, though rare, it can cause hypersensitivity reactions, including rash and swelling. - How should chlorhexidine mouthwash be used?
Rinse with 10–15 mL for 30 seconds twice daily. Do not swallow or rinse with water afterward. - Can chlorhexidine be used on open wounds?
Yes, but only with dilute formulations (e.g., 0.05%) to prevent tissue irritation. - Is chlorhexidine safe for pregnant women?
Yes, it is generally safe for topical and oral use during pregnancy. - Can children use chlorhexidine?
Yes, but oral use should be supervised to prevent accidental ingestion. - Does chlorhexidine stain teeth?
Prolonged use of mouthwash may cause temporary staining, removable by professional cleaning. - Can chlorhexidine be used in the ears or eyes?
No, it should not be used in the ears or eyes due to the risk of severe irritation or damage. - Does chlorhexidine interact with toothpaste?
Yes, toothpaste containing sodium lauryl sulfate may reduce its effectiveness. Use at different times. - What should I do if I swallow chlorhexidine?
Rinse your mouth thoroughly and seek medical attention if a large amount is swallowed. - How long does chlorhexidine take to work?
Antiseptic effects begin immediately and last for several hours. - Can chlorhexidine treat fungal infections?
It has some antifungal activity but is not the first-line treatment for fungal infections. - How should chlorhexidine be stored?
Store at room temperature, away from light and moisture.