Chlorhexidine

• A01AB03, B05CA02
• D08AC02, D09AA12
• R02AA05, S01AX09
• S02AA09, S03AA04

Antiseptic

Solid fuel

134-136 ° C

10.78 (25 ° C)

Poorly in water (800 mg · l-1 at 20 ° C)

Risk

• 21 mg · kg -1 ( LD50, rat, i.v.)
• 44 mg · kg -1 ( LD50, mouse, ip)

Template: Infobox chemical / molecular formula search available

Chlorhexidine (CHX ) is used especially in dentistry antiseptic. It is frequently used as chlorhexidine digluconate ( Chlorhexidinbis ( D-gluconate ) ).

Description

The molecule is in neutral aqueous solution before a double positive charge. It comes as chloride or acetate in the trade, for medical applications, the gluconate is most commonly used. The molecule is mirror-symmetrical and contains two benzene rings.

Chlorhexidine is due to its property of being able to fit into the bacterial membrane and thus to lead to the loss of small molecules and precipitation of cytoplasmic proteins, good antiseptic effect. Highest activity shows up against Gram - positive cocci, lower against gram -positive and - negative rods. Moderate activity can be observed in enveloped viruses. Acid-fast rods, non-enveloped viruses and spores are resistant.

It has the advantage of long teeth and oral mucosa to adhere ( substantivity ) without penetrating through the mucous membranes in the body ( chlorhexidine approximately 100% is excreted without being metabolized ). The effect consists in the destruction of the bacterial cell membrane.

Use

Chlorhexidine due to its non-specific antibacterial activity used as a mouthwash or as an applied coating on the teeth, which releases the active substance over a longer period of time ( about three to four months). Furthermore, chlorhexidine sprays, gels and chips exist. In dentistry is chlorhexidine in concentrations from 0.03 to 2 % is used ( as the chip up to 36% ) for the following indications:

• Preoperatively: Before prevent oral surgery in order to achieve a relative freedom from bacteria and bacteremia
• Postoperatively, in order to counteract the impaired oral hygiene in the operating area
• As primary care or supportive periodontal therapy in the context of: with gingivitis or periodontitis -related bacteria in the sense of all-round disinfection
• With ulcerating necrotizing gradients of gingivitis ( NUG ) or periodontitis ( NUP )

The clinical efficacy of the use of chlorhexidine as part of a mouth rinse is clear from a number of studies, which are summarized in review articles. In a direct comparison with other antibacterial compounds are chlorhexidine proves to be superior, which is attributed to the high substantivity of chlorhexidine.

Chlorhexidine mouthwashes contain in order to increase the effectiveness and durability as well as for the preservation despite possible health risks such as cancer often 6-7 % ethanol; However, there are also effective chlorhexidine mouthwashes without ethanol

Outside of dentistry, it takes place in the topical wound healing care use as a disinfectant, such as on patches, wound healing ointments as well as medicinal powder.

To find Chlorhexidinpuder application in the umbilical care of newborns. In a 2009 study published in the umbilical care has proven means Chlorhexidinpuder the dry care as superior. The results showed that " through the umbilical care with chlorhexidine powder (1%), the navel -related adverse events were significantly reduced in comparison to the dry nursing ". Similarly, chlorhexidine is used for skin disinfection and has been shown in a study in combination with a 70% 2- propanol solution, as PVP - iodine superior. Likewise, it is used together with mupirocin for the elimination of MRSA from the nasal vestibule.

Side effects

The use of chlorhexidine caused by prolonged use few, usually completely reversible side effects:

• Disturbance of the sense of taste ( dysgeusia )
• Brownish deposits on teeth, gums and tongue ( depending on the product to varying degrees)
• Desquamation of the epithelial cell layer (rare)
• Anaphylactic reaction

63 ( 4) :191 - fourth For permanent domestic use is recommended to alternately use on a weekly basis chlorhexidine and a chlorhexidine mouthwash not to reduce the side effects listed above. The brownish deposits on teeth and tongue stem from the fact that in the destruction of the bacterial cell membrane bacterial proteins are denatured while Disulfidfunktionen be reduced to thiol groups that form the iron (III ) ions of saliva dark colored complexes. Other stains may result in that dissolved in the saliva, monosaccharides such as glucose and fructose with the amine functions of bacterial proteins react ( Maillard reaction).

The original assumption that the extent of discoloration is proportional to the effectiveness of chlorhexidine-containing products ) must be taken for various reasons in doubt. As long as namely chlorhexidine can intercalate into the bacterial membrane and also the substantivity of chlorhexidine is not compromised, chlorhexidine-containing products should not lose their effectiveness. Attempts to prevent the brownish deposits by reducing agents such as ascorbic acid, that of iron (III ) ions to react, and nucleophiles such as sulfite ions, which react with glucose and fructose, were as successful. So it is clear from clinical studies with periodontitis patients that postoperative, seven-day, adjuvantive treatment with chlorhexidine (0.2%), ethanol-free mouthwashes by the addition of ascorbic acid and sulfite (Anti Discoloration System) is not affected, while the degree of discoloration can be significantly reduced by this addition. A clinical trial in healthy subjects, which did not examine the gingival status, but various plaque parameters, on the other hand came to the conclusion that there is a difference in effect in favor of the conventional formulation. The authors attributed this difference back not only to the absence of ethanol, but also that the ascorbic acid and sulfite could prevent the ethanol-free mouthwash the desired adhesion of chlorhexidine on teeth and gums. Why, however, the uncharged ascorbic acid or the negatively charged ascorbate or the negatively charged sulfite to prevent the adhesion of the doubly positively charged chlorhexidine on teeth and gums, the authors do not explain. The possible combination in terms of electrostatic attraction ( Coulomb's law ) between negatively charged sulfite or ascorbate and positively charged chlorhexidine to possibly insoluble chlorhexidine sulfite, chlorhexidine or ascorbate does not occur. The substantivity of chlorhexidine should therefore be preserved by the addition of sulfite or ascorbic acid. The ostensible contradictions of the gingival status study and the plaque study is probably due to the fact that different study parameters were chosen. Although plaque is a necessary condition for gum inflammation ( gingivitis), but leaves the plaque study in healthy volunteers, strictly speaking, no conclusions on the impact of a product on the gingival status of periodontitis patients. For the practitioner and his patients significantly the gingival status study should be.

The potential ototoxicity of skin disinfectants, also of chlorhexidine has been known since 1971. In the meantime, has been confirmed by repeated animal studies that chlorhexidine - if it gets into the middle ear, such as the presence of a perforated eardrum - can cause permanent hearing loss.

Properties

Chlorhexidine is poorly soluble in water but easily dissolved in organic solvents such as dichloromethane; in stark contrast to gluconate, which is readily soluble in water. Disables it is sodium lauryl sulfate and triclosan, both possible components of toothpastes. Therefore, a sodium lauryl sulfate and triclosanfreie toothpaste should be used during treatment with chlorhexidine. Alternatively, an interval of at least one hour between the brushing and the use of chlorhexidine are complied with.

Trade names

Antebor (CH ), anti- infect Dental Spray ( D, A), Bepanthen Antiseptic wound cream ( D), Bepanthen Plus ( CH), Cervitec gel / liquid / Plus (FL ), Chlorhexamed (D, A, CH), ChloSite gel ( EU, CH ), Cidegol (D), Collu - Blache (CH), Collunosol (CH), Corsodyl (CH), Curasept ADS (EU, CH), Dentohexin (CH), DermaPlast (CH), Dynexan Proactive (D), Eludril (CH), Hexal solution ( D), Hibidil Sterile solution (CH), Hibiscrub (CH), Hibital alcoholic solution / tincture (CH), Hibitane concentrate ( CH), Instillagel (D) LIFO Scrub ( CH), Lindosan wound and healing ointment ( A), Luuf Halspastillen / throat spray (A), Merfen (CH), meridol med CHX 0.2 % (D, CH), Neo - Angin Spray ( CH), Nystalocal (D, CH ), Paroex (D, F, CH, I), Paroguard (EU, CH), Perio -Aid (A, D, CH, D, NL, IT, UK ), PerioChip (D, A, NL, CH, IT, UK), PlacAway (GR), Skinsept F / mucosa (D), Uro- Tainer (CH), Vitaderm (A), Vita -hexyne (CH), Vita- Merfen (CH), Vitawund (A)