Chlorhexidine

 Risk Factor: B
 Class: ANTI-INFECTIVES / Antibiotics/Anti-infectives

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Chlorhexidine, a bisbiguanide antiseptic and disinfectant, is effective against most bacteria, and some fungi and viruses (including HIV). In addition to its topical use on the skin and intravaginally, it has been used for gingivitis and the prevention of dental plaque. Chlorhexidine has also been used as a spermicide (1). No adverse fetal effects were observed in pregnant rats administered chlorhexidine by gastric intubation on days 6 through 15 of gestation (2).

A number of studies have documented the safety and possible effectiveness of vaginal disinfection with chlorhexidine prior to delivery, primarily to prevent colonization of newborns with group B streptococci (3,4,5,6,7,8,9,10,11,12,13,14 and 15). Application to the groin and perineum, to the abdomen prior to cesarean section, and whole body washing has also been effective in preventing fetal and maternal infection (3,16,17,18 and 19). However, two double-blinded, placebo-controlled, randomized studies published in 1997, one utilizing a single intravaginal wash with 20 mL of a 0.4% chlorhexidine solution (20) and the other a 200 mL vaginal irrigation with a 0.2% solution (21), both groups in active labor, did not find a significant reduction in maternal infection rates compared with sterile water or saline. No adverse effects in the newborns were observed.

One author, hypothesizing an etiological connection between sudden infant death syndrome (SIDS) and toxigenic Escherichia coli or Chlamydia species, has suggested that decontamination of the birth canal with chlorhexidine during labor might reduce infant mortality from this disease (22), but a temporal relationship is speculative. In contrast to the real and theoretical benefits realized by the newborn from maternal chlorhexidine use, a single vaginal washing with a 0.4% chlorhexidine solution was not effective in decreasing the incidence of intra-amniotic infection or endometritis (23).

In one study involving nonpregnant women, swabbing of the entire vagina for 1 minute with gauze sponges soaked in 4% chlorhexidine gluconate did not result in detectable blood concentrations (sensitivity 0.1 mg/mL) of the agent (24). A second study, utilizing a method ten times more sensitive (sensitivity 0.01 mg/mL), was able to detect chlorhexidine in maternal blood from 34 of 96 women following vaginal washing with a 0.2% solution (25). Mean blood chlorhexidine concentrations obtained using two different methods of washing were 0.0146 mg/mL and 0.0104 mg/mL, respectively (range 0.010.083 mg/mL). No accumulation of chlorhexidine in maternal blood was observed after a second vaginal washing at 6 hours in 14 patients or after a third washing, 6 hours later, in 3. The disinfectant was not detected in 62 of the women.

One writer has cautioned that the potential long-term effects (not specified) in the newborn from exposure to respiratory and other epithelial surfaces following vaginal use of chlorhexidine during labor have not been investigated (26). However, no reports of adverse effects in newborns have been reported even though chlorhexidine is used commonly during labor and in the neonate. Moreover, only very small amounts of disinfectant reach the maternal circulation and, presumably, the fetus. Although the agent is an effective disinfectant, single vaginal applications of chlorhexidine solutions do not appear to offer any advantage over sterile water or saline in the prevention of maternal infections during labor or in the postpartum period.

Breast Feeding Summary

No reports describing the excretion of chlorhexidine into milk have been located. The presence of the drug in breast milk is probably clinically insignificant because of the very small amounts absorbed into the maternal circulation following vaginal washing. As a general precaution, the mother's nipples should be rinsed thoroughly with water if chlorhexidine is used on them as a disinfectant, even though absorption of the agent from the gastrointestinal tract is poor.

References

1. Editorial. Multipurpose spermicides. Lancet 1992;340:2113.
2. Gilman MR, De Salva SJ. Teratology studies of benzethonium chloride, cetyl pyridinium chloride and chlorhexidine in rats (Abstract). Toxicol Appl Pharmacol 1979;48:A35.
3. Vorherr H, Ulrich JA, Messer RH, Hurwitz EB. Antimicrobial effect of chlorhexidine on bacteria of groin, perineum and vagina. J Reprod Med 1980;24:1537.
4. Christensen KK, Christensen P, Dykes AK, Kahlmeter G, Kurl DN, Linden V. Chlorhexidine for prevention of neonatal colonization with group B streptococci. I. In vitro effect of chlorhexidine on group B streptococci. Eur J Obstet Gynecol Reprod Biol 1983;16:15765.
5. Dykes AK, Christensen KK, Christensen P, Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. II. Chlorhexidine concentrations and recovery of group B streptococci following vaginal washing in pregnant women. Eur J Obstet Gynecol Reprod Biol 1983;16:16772.
6. Christensen KK, Christensen P. Chlorhexidine for prevention of neonatal colonization with GBS. Antibiot Chemother 1985;35:296302.
7. Christensen KK, Christensen P, Dykes AK, Kahlmeter G. Chlorhexidine for prevention of neonatal colonization with group B streptococci. III. Effect of vaginal washing with chlorhexidine before rupture of the membranes. Eur J Obstet Gynecol Reprod Biol 1985;19:2316.
8. Christensen KK, Dykes AK, Christensen P. Reduced colonization of newborns with group B streptococci following washing of the birth canal with chlorhexidine. J Perinat Med 1985;13:23943.
9. Easmon CSF. Group B streptococcus. Infect Control 1986;7(Suppl 2):1357.
10. Dykes AK, Christensen KK, Christensen P. Chlorhexidine for prevention of neonatal colonization with group B streptococci. IV. Depressed puerperal carriage following vaginal washing with chlorhexidine during labour. Eur J Obstet Gynecol Reprod Biol 1987;24:2937.
11. Burman LG, Christensen P, Christensen K, Fryklund B, Helgesson AM, Svenningsen NW, Tullus K, and the Swedish Chlorhexidene Study Group. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet 1992;340:659.
12. Burman LG, Tullus K. Vaginal chlorhexidine disinfection during labour. Lancet 1992;340:7912.
13. Lindemann R, Henrichsen T, Svenningsen L, Hjelle K. Vaginal chlorhexidine disinfection during labour. Lancet 1992;340:792.
14. Henrichsen T, Lindemann R, Svenningsen L, Hjelle K. Prevention of neonatal infections by vaginal chlorhexidine disinfection during labour. Acta Paediatr 1994;83:9236.
15. Kolle LAA, Speyer I, van Kuijck MAP, Koopman R, Dony JM, Bakker JH, Wintermans RGF. Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel. Eur J Obstet Gynecol Reprod Biol 1989;31:4751.
16. Vorherr H, Vorherr UF, Moss JC. Comparative effectiveness of chlorhexidine, povidone-iodine, and hexachlorophene on the bacteria of the perineum and groin of pregnant women. Am J Infect Control 1988;16:17881.
17. Brown TR, Ehrlich CE, Stehman FB, Golichowski AM, Madura JA, Eitzen HE. A clinical evaluation of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation. Surg Gynecol Obstet 1984;158:3636.
18. Sanderson PJ, Haji TC. Transfer of group B streptococci from mothers to neonates: effect of whole body washing of mothers with chlorhexidine. J Hosp Infect 1985;6:25764.
19. Frost L, Pedersen M, Seiersen E. Changes in hygienic procedures reduce infection following caesarean section. J Hosp Infect 1989;13:1438.
20. Sweeten KM, Ericksen NL, Blanco JD. Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection. Am J Obstet Gynecol 1997;176:42630.
21. Rouse DJ, Hauth JC, Andrews WW, Mills BB, Maher JE. Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial. Am J Obstet Gynecol 1997;176:61722.
22. Elfast RA. Chlorhexidine prophylaxis at labor. Prevention of sudden infant death? Lakartidningen 1993;90:37712.
23. Eriksen NL, Blanco JD. Chlorhexidine versus sterile water vaginal wash during labor to prevent peripartum infection (Abstract). Am J Obstet Gynecol 1995;172:304.
24. Vorherr H, Vorherr UF, Mehta P, Ulrich JA, Messer RH. Antimicrobial effect of chlorhexidine and povidone-iodine on vaginal bacteria. J Infect 1984;8:1959.
25. Nilsson G, Larsson L, Christensen KK, Christensen P, Dykes AK. Chlorhexidine for prevention of neonatal colonization with group B streptococci. V. Chlorhexidine concentrations in blood following vaginal washing during delivery. Eur J Obstet Gynecol Reprod Biol 1989;31:2216.
26. Feldman R, van Oppen C, Noorduyn A. Vaginal chlorhexidine disinfection during labour. Lancet 1992;340:791.
    
    

Questions and Answers

Chlorhexidine?, Have you had to use Chlorhexidine for your gums? If you have, what was your experience using it like? Did it stain your teeth? Did it work? Thanks.

Chlorahexadine is used for gum disease, or to decrease the bacterial load. It does stain your teeth. It does work, I use it quite a bit for my patients now, and see a great improvements for some conditions.

How does Chlorhexidine kill or inhibit the growth or bacterial cells?, Chlorhexidine is used in mouthwash and is also known as corsodyl and it is an antiseptic that can attack gram-negative or gram positive bacterial cells but not many of gram-negative cells.

The mechanism of action is believed to be membrane disruption, and not ATPase inactivation as previously thought.

What specific type of toothpaste can a person use with Chlorhexidine Gluconate mouthwash?, I was wondering what specific type of toothpaste can a person use with Chlorhexidine Gluconate mouthwash?

any kind of toothpaste is good enough

Is chlorhexidine mouth wash effective in treating oral thrush?, Three weeks ago a have a couple of mouth sores at the back of my throat specially in the uvula area, they are so painful that I decided to take antibiotics treatment to speed the healing about a week after taking antibiotics I develop oral thrush inside my mouth which resulted in causing my tongue to have multiple small canker sores. I just want to ask if chlorhexidne mouth wash will help cure the thrush and what food can you recommend that contains antifungal properties? What is the sure fire home remedies to cure oral thrush?

There are no sure fire home remedies. You need one of 3 common prescriptions to take care of this. Eating yogurt MAY help somewhat, but if you have a full blown case of thrush, you need the Rx. (Mycostatin suspension, Mycelex Troche, or Diflucan tabs)

What's the difference between chlorhexidine digluconate and chlorhexidine gluconate?,

Digluconate is 2% and gluconate is 1%

What can I do to stop getting contact dermatitis from chlorhexidine wash??, It's the only hand wash in my workplace and I wash my hands after every patient... arrrggghhh. Also I use the alcohol rub which also contains chlorhexidine, I feel if I don't use these I am at risk of spreading bacteria. My hands get so itchy afterwards.... Can someone develop something that doesn't produce contact dermatitis

Your employer has an obligation to work with you to find a solution to your problem, including things like bringing in a different hand cleanser for you. But I wonder... do you think it is possible you have a latex sensitivity? When I switched to latex free gloves, the dermatitis on my hands resolved.

What is the point of rinsing with chlorhexidine after deep scaling-it makes no sense to me because the?, bacteria it needs to reach is not accessible-it is in the pockets-and I read the bottle and it actually claims that it cause tartar. What kind of catch-22 is that? Anyway, injecting the stuff into the pockets, perhaps, but as a rinse-what is the benefit?

As an ex-periodontal nurse I can tell you that the biggest benefit of rinsing with chlorhexidine after deep scaling is stopping infection in the areas that have been aggravated by the scaling. I have seen people who don't use it come back with localized infection in these pockets, which then need antibiotics and irrigation. The chlorhex kills bacteria in the whole mouth hence stopping those bacteria reaching into the pockets where it can set up a bad infection, and it does to an extent reach into the pockets as well.

As for causing tartar, this is not really the case as it does not make extra bacteria grow, but it can and often does cause discoloration of the existing tartar. This can very easily be scaled off by the dentist after you are finished you course of rinsing.

Other effects of chlorhex are discoloration of the tongue (which is temporary and not harmful) and some taste distortion (also temporary).

I would highly recommend using the mouthrinse as directed by you dentist/periodontist etc. as the benefits of chlorhexidine far outweigh the disadvantages which are mostly aesthetic and temporary. Much cheaper and easier to deal with than another infection!

Chlorhexidine, is it safe to use instead of locally injected antibiotics for deep cleanings?, Being that the dental insurance does not cover the injections

If you were told that you need antibiotics injected in your gum tissue there is a difference. The antibiotic you are talking about is called Arestin. This is used when you have deep pockets around your tooth, or you have irritation in that area due to a number of things. This works differently because it is injected into the socket, then it promotes healing over a long period or time. The rinse is something that they give you to use on a daily basis, or after a deep cleaning to also promote healthy gum tissue, there is a difference between the two. The rinse can cause staining over time. But both are for gum disease

How exactly do cetrimide and chlorhexidine gluconate, both of which are present in Savlon, kill bacteria?,

they are disruptors and disrupts bacterial cell walls..the polar cell walls of the bacterial is disruped and thus this leads to bacterial cell death

can chlorhexidine gluconate oral rinse be used to disinfect retainers and dentures?, I know its for my mouth but will it disinfect my retainer like efferdent does, and if it does is it bad for it at all?

You may not want to use it for too long cause what it does is cause staining, just like if you rinse with it for a long time, over time it will cause your teeth to stain because of the medication in it. My advice would be not to use it( I work as a dental assistant)