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Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant.

The efficacy of a new skin disinfectant, 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) isopropyl alcohol (IPA) (ChloraPrep), was compared with five commonly used skin disinfectants against Staphylococcus epidermidis RP62A in the presence or absence of protein, utilizing quantitative time-kill suspension and carrier tests. All six disinfectants [70% (v/v) IPA, 0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG, 0.5% (w/v) CHG in 70% (v/v) IPA and 10% (w/v) aqueous povidone iodine (PI)] achieved a log(10) reduction factor of 5, in colony-forming units/mL, in a suspension test (exposure time 30s) in the presence and absence of 10% human serum. Subsequent challenges of S. epidermidis RP62A in a biofilm (with and without human serum) demonstrated reduced bactericidal activity. Overall, the most effective skin disinfectants tested against S. epidermidis RP62A were 2% (w/v) CHG in 70% IPA and 10% (w/v) PI. These results suggest that enhanced skin antisepsis may be achieved with 2% (w/v) CHG in 70% (v/v) IPA compared with the three commonly used CHG preparations [0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG and 0.5% (w/v) CHG in 70% (v/v) IPA].

2-Propanol↗

Effect of smear layer and chlorhexidine treatment on the adhesion of Enterococcus faecalis to bovine dentin.

The aim of this in vitro study was to determine the effects of a smear layer and chlorhexidine (CHX) treatment on the adhesion of Enterococcus faecalis to bovine dentin. Forty dentin blocks from bovine incisors were prepared and randomly divided into four groups of 10 each. The blocks in group 1 were placed in sterile saline for 5 minutes, while those in group 2 were treated with 17% EDTA for 5 minutes. The blocks in group 3 were placed in 2% CHX for 7 days. The blocks in group 4 were treated with 17% EDTA for 5 minutes, and then placed in 2% CHX for 7 days. All the blocks were immersed in a suspension of E. faecalis for 3 hours. The bacteria adhering to the dentin surface were counted by examination using a scanning electron microscope. The most significant amount of bacteria was retained on the samples from group 1 (p < 0.05) and the smallest amount of bacteria adhered to the samples from group 4. These results suggest that a smear layer enhances the adherence of E. faecalis to the dentin, and CHX is effective in reducing the adherence of microorganisms.

Analysis of Variance↗

In vitro assessment of a gel base containing 2% chlorhexidine as a sodium perborate's vehicle for intracoronal bleaching of discolored teeth.

The purpose of this study was to assess a gel base containing 2% chlorhexidine (CHX) as a vehicle to be mixed with sodium perborate for intracoronal bleaching of discolored teeth, comparing its bleaching efficacy to sodium perborate mixed with other vehicles; 37% carbamide peroxide and 30% hydrogen peroxide. There were 110 fresh bovine incisors artificially stained using whole blood. The samples were divided into 11 groups and the intracoronal bleaching was performed using the "walking bleach technique". The bleaching agents were replaced three times at 7-day intervals. Using digital photos and a shade guide created for bovine teeth, the samples were evaluated at day 0, 7, 14, 21, and 28. On evaluation day, the photos were examined by three endodontists giving scores from 1 to 5 based on the shade guide created. Data were analyzed statistically by Kruskall-Wallis test. After 28 days, all evaluated teeth received scores that were statistically similar. Groups that used sodium perborate and a liquid vehicle bleached faster than those that used a gel based vehicle. The CHX gel allowed dissociation for the bleaching agent. The 2% CHX gel exhibited a good potential for use as a vehicle for sodium perborate or as a complement for carbamide peroxide.

Animals↗

Reactions of connective tissue to amalgam, intermediate restorative material, mineral trioxide aggregate, and mineral trioxide aggregate mixed with chlorhexidine.

The aim of this study was to histopathologically examine the biocompatibility of the high-copper amalgam, intermediate restorative material (IRM), mineral trioxide aggregate (MTA), and MTA mixed with chlorhexidine (CHX). This study was conducted to observe the rat subcutaneous connective tissue reaction to the implanted tubes filled with amalgam, IRM, MTA, and MTA mixed with CHX. The animals were sacrificed 15, 30, and 60 days after the implantation procedure. The implant sites were excised and prepared for histological evaluation. Sections of 5 to 6 microm thickness were cut by a microtome and stained with hemotoxylin eosin and examined under a light microscope. The inflammatory reactions were categorized as weak (none or few inflammatory cells < or =25 cells), moderate (>25 cells), and severe (a lot of inflammatory cells not to be counted, giant cells, and granulation tissue). Thickness of fibrous capsules measured five different areas by the digital imaging and the mean values were scored. Amalgam, IRM, and MTA mixed with CHX caused a weak inflammatory response on days 15, 30, and 60. MTA provoked an initial severe inflammatory response that subsided at the 30 and 60 day study period. A clear fibrous capsule was observed beginning from the 15 days in all of the groups. Within the limits of this study, amalgam, IRM, MTA, and MTA mixed with CHX materials were surrounded by fibrous connective tissue indicated that they were well tolerated by the tissues, therefore, MTA/CHX seemed to be biocompatible.

Aluminum Compounds↗

HPLC determination of chlorhexidine gluconate and p-chloroaniline in topical ointment.

A novel fast isocratic reversed-phase HPLC method for simultaneous determination of chlorhexidine and its degradation product p-chloroaniline was developed. Zorbax SB Phenyl column (75 mm x 4.6 mm, 3.5 microm) was used for the separation. Mobile phase composed of acetonitrile and buffer solution of 0.08 M sodium phosphate monobasic containing 5 ml of triethylamine (0.5%) and adjust with 85% phosphoric acid to pH 3.0 in ratio 35:65 (v/v) pumped isocratically at flow rate 0.6 ml min(-1) was used. UV detection was performed at 239 nm, the total analysis time was about 10 min. The method is suitable for practical routine analysis of topical ointment in the quality control laboratory.

Acetonitriles↗

The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva.

A randomized and cross-over design clinical study with normal adult volunteers examined the effects of a 0.12% chlorhexidine (CHX) mouthrinse and a control rinse on a range of microflora including those implicated in halitosis on the tongue and saliva. Saliva and tongue scrapings were collected from 13 subjects prior to treatments with additional samples collected at 3 h post-treatment cultured on media to enumerate anaerobic, Gram-positive and Gram-negative bacteria, odorigenic bacteria producing hydrogen sulphide (H2S) and oral bacteria with proteolytic activity. In comparison to the control, rinsing with CHX demonstrated statistically significant reductions that ranged from 81-90% for tongue microflora with a 89-95% decrease noted on salivary flora (p<0.05). The effects of CHX on anaerobic, Gram-positive and Gram-negative bacteria are in accord with those noted on odorigenic bacteria producing H2S or proteolytic activity. These results help to explain previous clinical results on the malodor efficacy of CHX and highlight microbiological approaches for bacteria implicated in malodor.

Adult↗

Chlorhexidine versus povidone-iodine for central venous catheter site care in children.

The number of children receiving central venous catheters (CVCs) for the administration of medications is at an all-time high. Unfortunately, placement of these CVCs is not without risks. Infection of CVC insertion sites is one of the most common, yet often preventable, causes of nosocomial bacteremia in both children and adults worldwide. Throughout the years, multiple practice recommendations have been made regarding the proper site care of CVCs. The most popular antimicrobial solution used for site care has traditionally been povidone-iodine. Chlorhexidine gluconate solution, however, has been shown to be more effective than povidone-iodine in preventing CVC-related infections in adults. There continues to be controversy regarding the efficacy and safety of antimicrobial solutions for pediatric CVC site care. An evidence-based approach was used to determine current recommendations for CVC site care in children.

Anti-Infective Agents, Local↗

New data on biological effects of chlorhexidine: Fe2+ induced lipid peroxidation and mitochondrial permeability transition.

Chlorhexidine (CHX) is a bis-bis-guanide with anphipatic and antiseptic properties and is largely used in dentistry, mainly for management of periodontal problems and in oral pre-operatory procedures. The present study concerns the effect of CHX on lipid peroxidation, mitochondrial permeability transition (MPT), and the interaction of CHX with ferritin (HoSF). CHX (100 microM) increased iron release from HoSF by approximately 13-fold when compared to control values. CHX also increased iron-dependent lipid peroxidation. MPT induced by CHX was protected by ethylene glycol-bis(beta-aminoethyl-ether)-N,N,N',N'-tetraacetic acid (EGTA), dithiothreitol (DTT), and cyclosporin A (CsA), showing a Ca2+-dependent effect, in which oxidation of thiol groups is involved, as well as the involvement of the transmembrane proteinaceous pore. BHT, catalase or o-phenanthroline did not protect MPT induced by CHX. This suggests that a ROS-independent mechanism is involved in the induction of MPT.

Animals↗

Chlorhexidine substantivity in root canal dentin.

OBJECTIVE: The purpose of this investigation was to evaluate the substantivity of chlorhexidine (CHX) within a root canal system and to assess how long the CHX remains antimicrobially effective. STUDY DESIGN: Bovine roots were sectioned and standardized to 8 mm. Sections, which served as controls, were treated with 1% sodium hypochlorite and 1 mol/L EDTA, then obturated with gutta percha and AH26 sealer. Experimental sections were treated similarly except they were placed in 2% CHX for 10 minutes prior to obturation. Control specimens were divided into 4 control groups and stored in saline for 1 day, 3 weeks, 6 weeks, and 12 weeks. Experimental specimens were divided into 4 groups and stored in saline for 1 day, 3 weeks, 6 weeks, and 12 weeks. After their respective storage periods, all specimens were halved and canal wall dentin was ground out with Peeso reamers. Dentin specimens were agitated in 700 microl of saline for 5 hours to release CHX. After centrifugation the supernatants were analyzed with UV spectrophotometry at 253 nm. To determine whether the CHX from dentin samples remained antimicrobial, the extracts from experimental and control groups were mixed with cultures of Enterococcus faecalis. RESULTS: After 1 day of storage, the dentin extract contained approximately 0.0048% CHX. After 3, 6 and 12 weeks, dentin extracts contained approximately 0.0023%, 0.0016%, and 0.0010% CHX respectively. Extracts from the storage groups were found to be highly antimicrobial corresponding to the CHX concentration. CONCLUSION: The results of this study indicate that CHX is retained in root canal dentin in antimicrobially effective amounts for up to 12 weeks.

Animals↗

Efficacy of chlorhexidine gluconate rinse for treatment and prevention of oral candidiasis in HIV-infected children: a pilot study.

PURPOSE: We evaluated the effect of chlorhexidine (CHX) 0.12% rinses on the clinical and microbiologic manifestations of oral candidiasis in HIV-infected children. STUDY DESIGN: This was a cross-sectional, clinical intervention study of 38 HIV-positive children. Inclusion in the study was based on oral examination and positive oral culture for Candida. At baseline, subjects with no clinical lesions but who were culture-positive for Candida (N = 9) were placed on preventive therapy of CHX q.d. for 90 days. Subjects with clinical oral candidiasis (N = 9) were placed on therapeutic CHX b.i.d. All 38 subjects received oral exams at monthly intervals. At 90 days oral mucosal samples were again taken for Candida. Colony-forming units (CFU) were determined before and after CHX treatment. RESULTS: Of 18 culture-positive subjects, 12 were included in the CFU analyses. After 3 months of CHX oral rinse therapy, Candida was undetectable in 3 children; another 8 showed an average 2-fold reduction in CFU. In 1 child the number of CFU increased modestly. Overall, the average pre- and posttreatment mean CFU was 6.18 +/- 2.19 and 2.73 +/- 3.15, respectively (P = .009). Five patients with clinical oral candidiasis at baseline, including all 3 who had pseudomembranous candidiasis, were free of signs of disease at the end of the study. CONCLUSIONS: This study suggests that the topical disinfectant CHX may be a promising agent for treating and preventing oral candidiasis in HIV-infected children.

Adolescent↗

Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review.

OBJECTIVE: The objective of this study was to assess if chlorhexidine (CHX) rinse decreases the occurrence of alveolar osteitis (AO) following third molar removal. STUDY DESIGN: A literature search identified 7 randomized prospective clinical trials reporting incidence of AO following removal of mandibular third molars. Studies were combined into 2 groups and summary relative risks were calculated for each group. One group of studies evaluated rinsing on the day of surgery only and the second group of studies rinsed at least on the day of surgery and several days after surgery. RESULTS: The relative risk for the single rinse group was 1.36 (95% confidence interval [CI] 0.80, 2.33), P>.05, whereas for the multiple rinse group, the relative risk was 1.90 (95% CI 1.46, 2.47), P<.05. CONCLUSION: Rinsing with CHX on the day of surgery and several days after may reduce the incidence of AO.

Anti-Infective Agents, Local↗

The sustaining effect of three polymers on the release of chlorhexidine from a controlled release drug device for root canal disinfection.

OBJECTIVES: The aim of this in vitro study was to evaluate the suitability of using chitosan, poly (lactide-co-glycolide) (PLGA), and polymethyl methacrylate (PMMA) to control the release of chlorhexidine digluconate (CHX) from a prototype of controlled release drug device for root canal disinfection. STUDY DESIGN: Four different prototypes with different formulations were prepared. Group A (n = 12): the device (absorbent paper point) was loaded with CHX as control. Group B (n = 12): same as group A, but the device was coated with chitosan (Texan MedTech). In Groups C and D, the device was treated in the same way as group A and then coated 3 times with 5% PMMA (Group C, n = 12, Aldrich), or coated 3 times with 3% PLGA (Group D, n = 12, Sigma). The devices were randomly allocated to experimental groups of 12 each. All the prototypes of controlled release drug device were soaked in 3 mL distilled water. The concentrations of CHX were determined using a UV spectrophotometer. The surface characteristics of each prototype were observed using a scanning electron microscope. RESULTS: The result showed that release rate of CHX was the greatest in the noncoated group, followed by the chitosan-coated group, the PLGA-coated group, and the PMMA-coated group (P < 0.05). Pores were observed on the surface of the prototypes that were coated with PLGA and PMMA. When the pore size was smaller, the release rate was lower. CONCLUSION: These data indicate that polymer coating can control the release rate of CHX from the prototypes of controlled release drug device.

Analysis of Variance↗

Disinfection of gutta-percha cones with chlorhexidine and sodium hypochlorite.

OBJECTIVES: To evaluate the effectiveness of chlorhexidine (CHX) or sodium hypochlorite (NaOCl) in disinfecting gutta-percha cones, to verify contamination of gutta-percha cones in their boxes, and to identify microorganisms after intentional contamination by handling cones. STUDY DESIGN: Gutta-percha cones contaminated in vitro with several microorganisms were left in contact with tested disinfecting solutions for different times, sterility of storage boxes was evaluated by immersing cones in broth medium, and the microorganisms most frequently found in handling cones were identified using biochemical tests. RESULTS: CHX was not effective in eliminating Bacillus subtilis spores on gutta-percha cones after 72 h of contact with the disinfecting substance. 5.25% NaOCl eliminated spores from gutta-percha after 1 min of disinfection. The cones evaluated from their boxes did not show contamination in 94.5% of the cases. The microbial genus most frequently found after intentional contamination with gloves was Staphylococcus. CONCLUSION: 5.25% NaOCl is an effective agent for a rapid disinfection of gutta-percha cones.

Anti-Infective Agents, Local↗

Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases.

OBJECTIVE: The purpose of this in vivo investigation is to compare the effect of a slurry of Ca(OH)2 mixed in aqueous 2% chlorhexidine (CHX) versus aqueous Ca(OH)2 slurry alone on the disinfection of the pulp space of failed root-filled teeth during endodontic retreatment. STUDY DESIGN: Forty single-rooted previously root-filled teeth with associated periradicular lesions were included. The teeth were nonsurgically retreated and medicated over 3 treatment visits with 7-10-day intervals with either Ca(OH)2 in water or Ca(OH)2 in 2% aqueous CHX. Root canal cultures were collected in fluid thioglycollate, and bacterial growth was assessed by turbidity daily for 1 week, then weekly for an additional 3 weeks. The presence of enterococci in the root canals at the initial treatment session was determined. RESULTS: Of the total sample population, 12 of 40 (30%) were positive for bacteria before root filling. The control medication disinfected 12 of 20 (60%) teeth including 2 of 4 teeth originally diagnosed with enterococci. The experimental medication resulted in disinfected 16 of 20 (80%) teeth at the beginning of the third appointment. None of the teeth originally containing enterococci showed remaining growth. This difference between the overall positive cultures was not statistically significant (P > .05). CONCLUSIONS: Canal dressing with a mixture of 2% CHX and Ca(OH)2 slurry is as efficacious as aqueous Ca(OH)2 on the disinfection of failed root-filled teeth.

Adult↗

In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament.

The aim of this study was to investigate the antimicrobial activity of calcium hydroxide (Ca(OH)2) combined with 2% chlorhexidine gluconate (CHX) gel against endodontic pathogens and to compare the results with the ones achieved by Ca(OH)2 mixed with sterile water and by CHX gel alone. Two methods were used: the agar diffusion test and the direct contact test. Ca(OH)2 + 2% CHX gel produced inhibitory zones ranging from 2.84 to 6.5 mm, and required from 30 seconds to 6 hours to eliminate all tested microorganisms. However, 2% CHX gel showed the largest microbial growth zones from 4.33 to 21.67 mm, and required 1 minute or less to inhibit all tested microorganisms. A paste of Ca(OH)2 plus sterile water inhibited only the microorganisms with which it was in direct contact and required from 30 seconds to 24 hours to kill all tested microorganisms. In conclusion, 2% CHX gel + Ca(OH)2 showed better antimicrobial activity than Ca(OH)2 manipulated with sterile water.

Anti-Infective Agents, Local↗

Effect of chlorhexidine on molecular weight distribution of fructans produced by fructosyltransferase in solution and immobilized on surface.

The effect of chlorhexidine (CHX), a potent antibacterial agent, was tested on the molecular weight distribution (MWD) of fructans synthesized by cell-free fructosyltransferase (FTF) in solution in comparison to FTF immobilized onto hydroxyapatite (HA). Size-exclusion chromatography (SEC) analysis has shown that cell-free FTF, both in solution and immobilized on HA, produces both low MW (1.9-2.2 kDa) and high MW (913-1047 kDa) fructans. CHX at a concentration of 0.02% altered the MWD of the fructans by reducing the polydispersity ratio and changing the MWD of the fructans synthesized both by immobilized FTF and by FTF in solution. These changes of the fructans in the presence of CHX adds a new prospective to the anticaries effect of CHX in addition to its antibacterial properties.

Anti-Bacterial Agents↗

Automated chromatographic determination of chlorhexidine in pharmaceutical preparations.

An automated method for the determination of chlorhexidine (Hibitane) and its salts in formulated pharmaceutical products is described. The equipment consists of a high efficiency liquid chromatograph, a variable wavelength high sensitivity ultraviolet spectrophotometric detector, the output of which is monitored simultaneously by a suitable recorder, and a digital computer. The sample is automatically introduced onto a 10-cm silica gel column by use of a slide valve. Results are calculated and printed out by the computer.

Biguanides↗