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PubMed1986

A comparison of the effects of chlorhexidine gluconate, amphotericin B and nystatin on the adherence of Candida species to denture acrylic.

Pretreatment of denture acrylic with nystatin, amphotericin B and chlorhexidine gluconate significantly reduced the subsequent adherence of Candida species to acrylic, although chlorhexidine and nystatin were more effective than amphotericin B. The duration of chlorhexidine-mediated inhibition of adherence (up to 19 days) was much longer than that of amphotericin B (24 h) or nystatin (48 h). Exposure of stationary-phase cells of Candida species for a short period to sublethal concentrations of chlorhexidine, or growth of Candida species with sublethal concentrations of chlorhexidine for 24 h resulted in a reduction in the ability of the yeasts to adhere to denture acrylic. The organisms grown in the presence of chlorhexidine were more susceptible to spheroplasting with Zymolyase 20T, indicating that chlorhexidine affects the cell surface composition of Candida species.

Acrylic Resins↗
PubMed2004

Sodium ferric gluconate complex in haemodialysis patients: a prospective evaluation of long-term safety.

BACKGROUND: A previous single dose placebo-controlled double-blinded trial showed an extremely low (0.4%) intolerance rate of sodium ferric gluconate complex (SFGC) in SFGC-naive haemodialysis patients. No large prospective trials have assessed the safety of SFGC during repeated exposure in the outpatient haemodialysis setting. METHODS: Chronic haemodialysis patients completing the single-dose trial of SFGC were eligible to participate in this prospective, multicentre, open-label, long-term evaluation of SFGC, designed to record adverse events occurring up to 72 h post-dose. Patients received as many as 20 ampules (1250 mg total) of SFGC at an investigator-determined dose and rate over a 9 month evaluation period. RESULTS: Among 1412 enrolled patients at 54 centres, 1321 received 13,151 infusions of SFGC. Most doses (94.8%) were < or =125 mg and the majority were given over 10 min. Infusion rates ranged from <5 to 125 mg/min. There were no life-threatening events. Fifty-one patients (3.9%) experienced an adverse event, possibly related to SFGC. Of these, one experienced a serious event (hypotension). Five patients (0.4%) experienced an event that precluded SFGC readministration: pruritus (three), vasodilatation (one) and loss of taste (one). Among 372 patients (28.2%) receiving angiotensin-converting enzyme inhibitor (ACEI) therapy, adverse events were neither more common nor more severe than in the other patients. CONCLUSIONS: Repeated doses of SFGC are very well tolerated in haemodialysis patients. No life-threatening events were observed in over 13,000 doses administered. Administration of SFGC to patients using ACEI is safe and does not increase the incidence or severity of adverse events to SFGC.

Aged↗
PubMed1996

'Oversaturation' of transferrin after intravenous ferric gluconate (Ferrlecit(R)) in haemodialysis patients.

BACKGROUND: Chronic haemodialysis causes blood loss and iron-deficiency. This can be corrected with intravenous preparations, e.g. sodium ferric-gluconate (FeGl). In two patents complaints of hypotension and malaise during FeGl infusion coincided with high levels of serum iron and a calculated transferrin iron saturation above 100%. Iron toxicity could be the cause of these complaints. Free iron is known to aggravate the toxicity of free radicals and other reactive oxygen products that are constantly formed in the body. We compared four rates of FeGl infusion with regard to iron parameters. METHODS: 20 dialysis patients received a total of 26 infusions of FeGl. A rapid infusion of 135 mg (Protocol A (n=10)) or 62.5 mg (Protocol B (n=7)) of FeGl was given during the last 30 min of dialysis. A slow infusion of 125 mg (Protocol C (n=9)) or 62.5 mg (Protocol D (n=10)) was given during 4 or 4.5 h of dialysis. Blood was taken at regular intervals, before, during, and after dialysis for determination of serum iron, transferrin, ferritin, haematocrit, total protein, albumin, and lactate dehydrogenase (LDH). Transferrin saturation was calculated from transferrin and serum iron. RESULTS: With rapid infusion A (125 mg) the highest levels of serum iron (median 120 (range 40-159) micromol/l) and transferrin saturation (207 (84-331)%) were seen at the end of the infusion. These were significantly higher than the peak levels with B, C, and D (P</=0.03). With rapid infusion B (62.5 mg), peak levels were intermediately high (serum iron 61 (50-96) micromol/l; transferrin saturation 118 (91-174)%). With slow infusion C (125 mg) similar peak levels were seen (serum iron 83 (43-106) micromol/l; transferrin saturation 141 (88-172)%). With slow infusion D (62.5 mg), the lowest peak levels were seen (serum iron 38 (31-55) micromol/l; transferrin saturation 78 (43-92)%). These levels were significantly lower than those with A, B and C (P<=0.002). Only with D all patients showed a transferrin saturation lower than 100%. Ferritin was increased before the next dialysis in all patients. LDH was not significantly elevated during any infusion. CONCLUSIONS: The commonly used rapid infusion rate (A) of FeGl causes 'oversaturation' of transferrin. This is compatible with iron toxicity due to free iron which may explain our patients' complaints. Free iron cannot be measured directly. LDH as a crude measure of cell damage was not elevated. Better measurements to prove free iron toxicity, like lipid peroxides, are not yet readily available. Infusion during a longer period at a lower dose (D) is effective and eliminates 'Oversaturation' of transferrin and probably the danger of iron toxicity.

Adult↗
PubMedDate not supplied

Wet disc testing of mafenide hydrochloride, chlorhexidine gluconate, and triple antibiotic solution against bacteria isolated from burn wounds.

Various antimicrobial solutions for topical use on burn wounds tested, in vitro with a newly described wet disc assay, for their activity against bacterial isolates from patients with burns. The antimicrobial activity of triple antibiotic solution was shown to reside in the neomycin component. The activity of 2.5% mafenide hydrochloride solution was equal to that of 4% mafenide HCl and could be used clinically with significant savings and perhaps, fewer side effects. Chlorhexidine gluconate had broad antimicrobial activity in an 0.05% solution in water; however, dissolving the active ingredient in saline nullified its activity significantly. The wet disc assay appears to be a useful means by which to assess the efficacy of solutions for topical use.

Bacitracin↗
PubMedDate not supplied

Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine, and isopropanol.

A comparison was made of the residual microbiologic contamination on transplantable allograft skin for burn wound coverage taken from cadaver donors prepared by two different protocols. One group was prepared with povidone-iodine, detergent, and 70% isopropanol; the other was prepared with these agents and 4% chlorhexidine gluconate (CG). The skin from each of the donor bodies was removed from independently prepared body areas. Without CG, 13.7% of donor body areas were contaminated; with CG, only 5.6% were contaminated. The number of gram-positive bacterial species isolated from skin after CG preparation was dramatically reduced. The gram-positive bacterial contamination rate dropped from 12.1% to 2.2% of donor body areas, a drop of 82%. With CG, 12 of the 15 contaminant species were eliminated; and we saw a general reduction in the total number of contaminated body areas, a specific and pronounced reduction in gram-positive bacteria, and an increase from 86.3% to 94.4% in the amount of skin obtained from donor cadavers that tested negative for bacterial contamination.

1-Propanol↗
PubMed2004

Antibacterial activity of 2% chlorhexidine gluconate and 5.25% sodium hypochlorite in infected root canal: in vivo study.

In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution.

Adult↗
PubMed2004

Antibacterial efficacy of calcium hydroxide and chlorhexidine gluconate irrigants at 37 degrees C and 46 degrees C.

This study investigated the ability of two endodontic irrigants to eliminate Enterococcus faecalis from dentinal tubules, and whether their antimicrobial action was enhanced by heat. The lumens of disks prepared from extracted bovine roots were infected with E. faecalis and incubated for 72 h. Specimens were then filled with saline, 10% calcium hydroxide (Ca(OH)2), or 0.12% chlorhexidine gluconate (CHX) at 24 degrees C or 46 degrees C and incubated at 37 degrees C or 46 degrees C. The samples were then pulverized and plated to quantify residual bacteria. No statistical difference (p > 0.05) in bacterial growth was seen between the two saline groups, or between the two medication groups at a given temperature. CHX and Ca(OH)2 at either temperature produced significantly less growth than either saline group, and CHX or Ca(OH)2 at 46 degrees C produced significantly less growth than either group at 37 degrees C. Heat enhanced the antibacterial action of both experimental irrigants against E. faecalis, but heating saline produced no increase in bactericidal effect.

Animals↗
PubMed1984

Synthesis of l-(+)-Tartaric Acid from l-Ascorbic Acid via 5-Keto-d-Gluconic Acid in Grapes.

5-Keto-l-idionic acid ( identical with5-keto-d-gluconic acid, d-xylo-5-hexulosonic acid) was found as a metabolic product of l-ascorbic acid in slices of immature grapes, Vitis labrusca L. cv ;Delaware'. Specifically labeled compounds, recognized as metabolic products of l-ascorbic acid in grapes, were fed to young grape tissues to investigate the metabolic pathway from l-ascorbic acid to l-(+)-tartaric acid.Label from dehydro-l-[1-(14)C]ascorbic acid, 2-keto-l-[1-(14)C]idonic acid (l-xylo-2-hexulosonic acid), l-[1-(14)C]idonic acid, or 5-keto-l-[1-(14)C] idonic acid was incorporated into l-(+)-tartaric acid in high yields as it was in the l-[1-(14)C]ascorbic acid experiment. In a double label experiment involving a mixture of l-[1-(14)C]idonic acid and l-[2-(3)H]idonic acid, the (3)H/(14)C ratios of 5-keto-l-idonic acid and l-(+)-tartaric acid synthesized in young grape leaves were almost the same as the value of the l-idonic acid fed. Label from 5-keto-l-[6-(14)C]idonic acid was incorporated into sugars and insoluble residue in the same way as l-[6-(14)C]ascorbic acid was metabolized in grapes.These results provide strong evidence that in grapes l-(+)-tartaric acid is synthesized from the C(4) fragment that corresponds to the C1 to C4 group of the 5-keto-l-idonic acid derived from l-ascorbic acid via 2-keto-l-idonic acid and l-idonic acid.

Journal Article↗
PubMed1991

The effect of nifedipine on the disposition of strontium gluconate used as a kinetic marker for calcium in healthy volunteers.

1. We have studied the disposition of stable strontium after the intravenous administration of strontium gluconate to eight healthy male volunteers both in control conditions and while they were taking the calcium antagonist nifedipine 10 mg three times daily. 2. Nifedipine, presumably by its action in blocking voltage-operated calcium channels, altered the in vivo disposition of strontium, causing large reductions in the half-life and the apparent volume of distribution of strontium. Total and renal clearances of strontium were unaltered by nifedipine. 3. These results support our previous suggestion that the delineation of strontium disposition can be used as a means of studying calcium disposition in vivo in man, and of studying the effects of drugs and diseases on that disposition.

Adult↗
PubMed1991

Intravenous strontium gluconate as a kinetic marker for calcium in healthy volunteers.

1. We have studied the pharmacokinetics of stable strontium in 10 healthy male volunteers. We gave each volunteer 5 mmol strontium gluconate by intravenous infusion over 1 h and measured strontium concentrations in plasma and urine samples for 20 days. The plasma strontium concentration vs time data for each volunteer were fitted by a triexponential function using NONLIN. Compartmental model-dependent and model-independent pharmacokinetic variables were then calculated. 2. The mean half-life we report (5.4 days) is longer than that previously reported (about 2 days), since we continued sampling for 20 days. However, the rates of clearance (CL 9.4 ml min-1. CLR 5.4 ml min-1, and CLNR 4.0 ml min-1) are similar to those previously reported, and the apparent volume of distribution at steady state (64 l) is similar to the values previously reported for the size of the exchangeable pool of both strontium and calcium. 3. The similarities in the pharmacokinetic behavior of strontium and calcium suggest that the in vivo disposition of strontium may be used as a marker of calcium disposition and for studying the effects of drugs such as the calcium antagonists.

Adult↗
PubMed1987

The sporicidal activity and inactivation of chlorhexidine gluconate in aqueous and alcoholic solution.

The sporicidal activity of chlorhexidine gluconate in aqueous and alcoholic solution against spores of Bacillus subtilis was examined over a broad temperature range. Activity was not observed at 20 degrees C even with concentrations as high as 10% chlorhexidine. Temperatures of 37 degrees-70 degrees C in combination with such high concentrations were required for reductions in spore viability. No viable spores were recoverable after 4 h contact at 55 degrees C with 10% aqueous chlorhexidine and none after 3 h contact with the alcoholic solution. Because of the high concentrations necessary for activity and the possibility of sporostasis occurring from inefficient chlorhexidine inactivation, existing inactivation systems were examined and modified to obtain satisfactory results. The spores of other Bacillus species examined (B. cereus, B. megaterium and B. stearothermophilus) proved to be considerably less resistant than those of B. subtilis. Presence of organic matter had little effect on the activity.

Bacillus subtilis↗
PubMed2005

Sodium ferric gluconate for post-transplant anemia in pediatric and young adult renal transplant recipients.

Post-transplant anemia is a widespread problem among pediatric renal transplant recipients. Many clinicians treat post-transplant anemia in a manner similar to treatment of anemia in dialysis patients, including the use of intravenous iron, such as sodium ferric gluconate (SFG). Data on pediatric dosing of SFG are limited to rare small series containing few or no renal transplant recipients. We conducted a retrospective chart review of practice patterns at our institution to evaluate doses used, hemoglobin response and adverse events. We identified 15 renal transplant recipients who received SFG during the 28-month study period. Data from 14 of these patients were available for analysis. Patients received between one and six doses of SFG to yield a total dose of 100-1000 mg or 2.7-23.7 mg/kg. The largest doses given during a single infusion ranged from 1.9 to 6.4 mg/kg. The mean hemoglobin level increased from 101 +/- 16 to 114 +/- 21 g/L (p = 0.0092) following SFG therapy. Adverse events were recorded for three patients. Treatment with SFG appears to yield some improvement in anemia in renal transplant recipients, but the paucity of published information on this topic highlights the need for stronger data, particularly with respect to pediatric patients.

Adolescent↗
PubMed1995

Uptake of 14C-chlorhexidine gluconate by Saccharomyces cerevisiae, Candida albicans and Candida glabrata.

Uptake of radiolabelled chlorhexidine gluconate (14C-CHG) to Saccharomyces cerevisiae, Candida albicans and C. glabrata was very rapid and near maximal within 30 s. The organism, S. cerevisiae, most sensitive to the lethal action of chlorhexidine, took up significantly more biocide than the other organisms. Cells from cultures of different ages took up different amounts of 14C-CHG.

Anti-Infective Agents, Local↗
PubMed1995

Effects of chlorhexidine gluconate on the development of spores of Bacillus subtilis.

The effects of sublethal concentrations of the membrane-active agent chlorhexidine gluconate (CHG) on the growth rate and sporulation of Bacillus subtilis vegetative MB2 cells have been investigated. CHG increased the mean generation time (Mgt) of vegetative cells in casein medium. It also affected spore development: as CHG concentrations increased, spore index (SI) values decreased and sensitivity to both toluene and heat increased.

Bacillus subtilis↗
PubMedDate not supplied

A prospective comparison between stabilized glutaraldehyde and chlorhexidine gluconate for preoperative skin antisepsis in dogs.

OBJECTIVE: To compare the efficacy of 0.3% stabilized glutaraldehyde and alcohol (SG+A), 0.3% SG and water (SG+W), and 4% chlorhexidine gluconate tincture (CG+A), as skin disinfectants in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, blinded clinical study. ANIMALS: One hundred and twenty-one dogs. METHODS: Cutaneous bacterial colony forming units (CFU) from the perioperative site after skin preparation, after antisepsis, and after surgery (incisional and paramedian), were quantified. The influence of high initial bacterial counts (> or =150 CFU) and surgical time on antibacterial efficacy was examined and the proportion of dogs from which Staphylococcus intermedius was cultured, determined. Perioperative skin reactions and wound infections were documented. RESULTS: All 3 antiseptic solutions significantly and equally reduced CFU to all post-antisepsis sampling levels irrespective of surgical duration (mean surgical times 151.6, 136.2, and 149.6 minutes for CG+A, SG+A and SG+W, respectively). Median percentage reductions in CFU ranged between 99.3% and 100%. In dogs with initial high counts and disinfected with CG+A and SG+W, the incisional samples had significantly higher counts than the post-antisepsis samples. In the CG+A and SG+W groups, the proportion of post-surgery samples yielding S. intermedius was significantly higher at the incisional than the paramedian sites. Eight mild cutaneous reactions were recorded in equal proportions for the 3 solutions. There were no recorded infections. CONCLUSIONS: All 3 preparations had an equal ability to reduce and maintain low CFU counts, with minimal cutaneous reactions. CLINICAL RELEVANCE: SG solutions are safe and effective preoperative skin antiseptics for elective clean-contaminated surgical procedures.

Administration, Cutaneous↗
PubMed1983

Comparison of plaque accumulation after topical application and mouth rinsing with chlorhexidine gluconate.

This study measured plaque accumulation on anterior teeth after topical or mouth rinse application of 0.2% chlorhexidine gluconate. Compared with water plaque scores were highly significantly reduced. There was no significant difference in plaque scores between topical application or mouth rinsing. The importance of locally adsorbed chlorhexidine is emphasised and the relevance of an oral reservoir effect questioned.

Administration, Topical↗
PubMed1997

Effects of tetracycline hydrochloride and chlorhexidine gluconate on Candida albicans. An in vitro study.

This study examined the effects of tetracycline hydrochloride (TCN) and chlorhexidine gluconate (CHX) on the growth and viability of Candida albicans. Subcultures of Candida albicans on Sabouraud's agar, were divided into 5 treatment groups: group 1, untreated control; group 2, 0.12% CHX; group 3, 3.0 mg/ml TCN adjusted to pH 4.5; groups 4 and 5, sodium azide free Tris buffer adjusted to pH 4.5 and pH 7.4, respectively. All groups were incubated for 10 days, and sampled and subcultured daily to determine the viability of each group. Additional samples from group 2 (day 4), group 4 (day 7) and all groups at day 10 were selected for SEM and TEM examination. Visual, SEM and TEM results showed that for groups 1, 3, 4, and 5 there was a heavy and constant uniform growth of Candida albicans throughout the period of the study. However, group 2 (CHX), showed decreasing viability and attachment from day 3 to day 10, with SEM and TEM revealing decreased blastospores and profound changes in the ultrastructural morphology, indicating inhibition of normal cell growth and replication. These results show that TCN even when used at high concentrations, in vitro, will allow uninhibited growth of Candida albicans whereas CHX inhibits cell growth and replication.

Adhesiveness↗
PubMed1995

Residual effect of chlorhexidine gluconate in 4-day plaque regrowth crossover trials, and its implications for study design.

The efficacy of oral hygiene agents in preventing the accumulation of plaque from a zero baseline is conveniently evaluated in the 4-day plaque regrowth model. In many studies a panel of volunteers has been used to compare several agents according to a highly efficient Latin square based crossover design. Often chlorhexidine gluconate is included as a positive control; there is concern that the effect of this potent agent might persist for longer than the 3-day washout period often employed. To test this hypothesis of residual effect, we put together the evidence relating to possible carryover from 12 studies. The residual effect of chlorhexidine differs from that of an inert rinse such as saline or water. Consequently, a longer washout period, such as 10 days, is preferable. Studies omitting chlorhexidine are worth considering. Designs should be balanced for residual effects, at least from the preceding treatment period; several useful designs with this property are presented.

Chlorhexidine↗