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SENSORY ORGANS › OPHTHALMOLOGICAL AND OTOLOGICAL PREPARATIONS › ANTIINFECTIVES › Antiinfectives
chlorhexidine
S03AA04
Forms & Strengths
- Topical solution 0.5% (skin antiseptic)
- Topical solution 2% (pre‑operative skin prep)
- Topical solution 4% (surgical hand scrub)
- Oral rinse 0.12% (mouthwash)
- Oral rinse 0.2% (post‑operative)
- Gel 2% (wound care)
- Wipes impregnated with 2% solution
- Catheter lock solution 2% (intravenous)
Adult Dosing
- Skin prep: apply 2–5 mL of 2% solution, allow to dry before incision
- Surgical hand scrub: 4% solution, scrub for 3 min, rinse
- Oral rinse: 15 mL of 0.12% solution, swish 30 s, twice daily
- Catheter lock: fill lumen with 2% solution, dwell 30 min, then withdraw
- Wound irrigation: 2% solution, 10‑20 mL per wound, gentle lavage
- Diaper rash prophylaxis: apply thin film of 0.5% solution twice daily
Pediatric Dosing
- Skin prep (≥2 y): 1–2 mL of 2% solution, dry before procedure
- Neonates/infants: avoid oral rinse; use 0.5% solution for skin prep only
- Oral rinse (≥6 y): 10 mL of 0.12% solution, swish 30 s, once daily
- Catheter lock (≥12 y): 0.5 mL of 2% solution per lumen, dwell 30 min
- Wound care: 1–2 mL of 2% solution per wound, as needed
Indications
- Pre‑operative skin antisepsis
- Surgical hand preparation
- Oral rinses for gingivitis, post‑operative oral hygiene
- Catheter lock to prevent bloodstream infection
- Wound cleansing and dressing
- Diaper‑rash prevention in infants
- Preparation of peripheral IV insertion sites
Mechanism of Action
- Cationic bisbiguanide binds to negatively charged bacterial cell walls
- Disrupts membrane integrity, causing leakage of intracellular contents
- Precipitates cytoplasmic proteins, leading to rapid bactericidal effect
- Broad‑spectrum activity: gram‑positive, gram‑negative, anaerobes, yeasts, enveloped viruses
Contraindications
- Known hypersensitivity to chlorhexidine or related compounds
- Severe mucosal lesions (e.g., oral ulcerations) for oral rinse
- Use in eyes unless specifically formulated for ophthalmic use
- Patients with a history of anaphylaxis to chlorhexidine
Adverse Reactions
- Local skin irritation, erythema, or contact dermatitis
- Rare anaphylactic reactions (urticaria, bronchospasm, hypotension)
- Taste alteration and temporary staining of teeth/tongue
- Chemical burns with prolonged exposure or high concentration
- Transient tinnitus if otic exposure occurs
Drug Interactions
- Inactivated by anionic surfactants (e.g., soaps, sodium lauryl sulfate in toothpaste)
- Reduced efficacy when used immediately after povidone‑iodine
- Potential additive irritation with topical anesthetics or corticosteroids
- May increase systemic absorption of concurrently applied drugs through compromised skin
Curated Content: Needs Vetting Before Put to Clinical Use