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Concept
Chlorhexidine
Summary
Chlorhexidine is a disinfectant and antiseptic with the molecular formula C22H30Cl2N10, which is used for skin disinfection before surgery and to sterilize surgical instruments. It is also used for cleaning wounds, preventing dental plaque, treating yeast infections of the mouth, and to keep urinary catheters from blocking. It is used as a liquid or a powder. It is known by the salt forms: chlorhexidine gluconate (chlorhexidine digluconate) and chlorhexidine acetate (chlorhexidine diacetate).
Side effects may include skin irritation, tooth discoloration, and allergic reactions, although the risk appears to be the same as other topical antiseptics. Chlorhexidine rinse is also known to have a bitter metallic aftertaste. Rinsing with water is not recommended as it is known to increase the bitterness. It may cause eye problems if direct contact occurs. Use in pregnancy appears to be safe. Chlorhexidine may come mixed in alcohol, water, or surfactant solution. It is effective against a range of microorganisms, but does not inactivate spores.
Chlorhexidine came into medical use in the 1950s. Chlorhexidine is available over the counter in the United States. It is on the World Health Organization's List of Essential Medicines. In 2020, it was the 273rd most commonly prescribed medication in the United States, with more than 1 million prescriptions.
Chlorhexidine is used in disinfectants (disinfection of the skin and hands), cosmetics (additive to creams, toothpaste, deodorants, and antiperspirants), and pharmaceutical products (preservative in eye drops, active substance in wound dressings and antiseptic mouthwashes). A 2019 Cochrane review concluded that based on very low certainty evidence in those who are critically ill "it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions."
In endodontics, chlorhexidine has been used for root canal irrigation and as an intracanal dressing but has been replaced by the use of sodium hypochlorite bleach in much of the developed world.
Official source
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