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Disposition in rats of the carbohydrate polymer in Ferastral--an iron-poly (sorbitol-gluconic acid) complex.

The disposition and pharmacokinetics in rats of 14C-sorbitol-Ferastral has been studied as an initial step towards elucidating the metabolic fate of the polymeric organic moiety. The period of time studied was 24 h. Following i.v. administration of a dose corresponding to 10 mg/kg of iron approximately 60% of the isotope was found in the urine after this period of time. A further 3% was demonstrated in the faeces whilst the expired air accounted for about 10% in the form of 14CO2. Thus, a relatively large proportion of the radiolabel was promptly excreted via the kidneys whilst the expired air and probably bile constituted secondary excretion routes. The physico-chemical nature of the urinary product was similar to the parent carbohydrate compound. The residual 14C radioactivity was distributed mainly between the liver, which contained approximately 45% of the retained label, carcass with 36% and large intestine with 7%. The plasma disappearance pattern was biphasic. Similar experiments with the 14C-sorbitol polymer starting material were performed for purposes of comparison.

Animals↗

Adaptation and growth of Serratia marcescens in contact lens disinfectant solutions containing chlorhexidine gluconate.

Serratia marcescens (11 of 12 strains) demonstrated an ability to grow in certain chlorhexidine-based disinfecting solutions recommended for rigid gas-permeable contact lenses. For a representative strain, cells that were grown in nutrient-rich medium, washed, and inoculated into disinfecting solution went into a nonrecoverable phase within 24 h. However, after 4 days, cells that had the ability to grow in the disinfectant (doubling time, g = 5.7 h) emerged. Solutions supporting growth of S. marcescens were filter sterilized. These solutions, even after removal of the cells, showed bactericidal activity against Pseudomonas aeruginosa and a biphasic survival curve when rechallenged with S. marcescens. Adaptation to chlorhexidine by S. marcescens was not observed in solutions formulated with borate ions. For chlorhexidine-adapted cells, the MIC of chlorhexidine in saline was eightfold higher than that for unadapted cells. Cells adapted to chlorhexidine showed alterations in the proteins of the outer membrane and increased adherence to polyethylene. Cells adapted to chlorhexidine persisted or grew in several other contact lens solutions with different antimicrobial agents, including benzalkonium chloride.

Adaptation, Biological↗

A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates.

UNLABELLED: Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). PURPOSE: A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. METHODS: Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. RESULTS: Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing </=1000 g. No neonates in the PI group developed contact dermatitis. CONCLUSION: The novel chlorhexidine-impregnated dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and redressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.

Administration, Cutaneous↗

A comparison of a periodontal dressing and chlorhexidine gluconate mouthwash after the internal bevelled flap procedure.

A group of 15 patients requiring comparable bilateral internal bevelled flap procedures took part in a study to compare the clinical results achieved when a dressing or chlorhexidine mouthwash was used during the first postoperative week. Initial preoperative conditions were comparable. At the end of the first postoperative week, significantly more plaque accumulated and the sulcus bleeding index was significantly higher on the dressing treated side. At 1 month and 3 months postoperatively the sulcus bleeding indices were below preoperative levels for both treated sides with no significant differences between the sides. A significant and comparable reduction in pocket depths occurred following the two postoperative treatments. Subjectively recorded pain scores demonstrated that more pain was experienced on the dressing treated side, particularly during the first 4 postoperative days. More patients preferred the mouthwash as a postoperative treatment.

Adult↗

Clinical enhancement of post-periodontal surgical therapy by a 0.12% chlorhexidine gluconate mouthrinse.

Previous studies have demonstrated the potential beneficial effects of post-surgical rinsing with 0.2% chlorhexidine. In the present investigation a new chlorhexidine formulation (Peridex) (CHx) and concentration (0.12%) was evaluated clinically to determine if similar effects could be detected from the use of the new product and treatment regimen. A double blind, randomized, placebo-controlled study was carried out in 40 patients during a 6 week period. Patients who had moderate periodontitis (AAP Class III) received osseous periodontal surgery in one quadrant. Each surgical site received periodontal dressing and patients were given a placebo or CHx mouthrinse to be used twice each day. Compared to placebo, CHx significantly reduced plaque at all examinations (54.4% reduction over placebo at 6 weeks, P less than 0.05). Visible plaque (PlI greater than 2) in the CHx group was reduced by 99% over the placebo group at 6 weeks and at 4 weeks post-surgical, gingival inflammation scores were significantly lower in the CHx group (17% reduction over the placebo at 4 weeks, P less than 0.05). Gingival bleeding scores (GI greater than 2) were significantly lower in the CHx group at 4 and 6 weeks (41% and 40% reduction over the placebo group, P less than 0.05). Probing pocket depth and attachment level changes were not significantly different between both groups. Epithelialization rates and pain assessment demonstrated consistently better results in the CHx group, although differences were not statistically significant. Use of 0.12% chlorhexidine immediately following periodontal surgery, for 6 weeks, has been shown to be a clinically effective adjunct providing enhancement of the post-surgical management of periodontal surgical patients.

Chlorhexidine↗