Antiseptics



Definition

An antiseptic is a substance that inhibits the growth and development of microorganisms. For practical purposes, antiseptics are routinely thought of as topical agents, for application to skin, mucous membranes, and inanimate objects, although a formal definition includes agents that are used internally, such as the urinary tract antiseptics.


Purpose

Antiseptics are a diverse class of drugs that are applied to skin surfaces or mucous membranes for their anti-infective effects. This may be either bacteriocidal (kills bacteria) or bacteriostatic (stops the growth of bacteria). Their uses include cleansing of skin and wound surfaces after injury, preparation of skin surfaces prior to injections or surgical procedures, and routine disinfection of the oral cavity as part of a program of oral hygiene. Antiseptics are also used for disinfection of inanimate objects, including instruments and furniture surfaces.

Commonly used antiseptics for skin cleaning include benzalkonium chloride, chlorhexidine, hexachlorophine, iodine compounds, mercury compounds, alcohol, and hydrogen peroxide. Other agents that have been used for this purpose, but have largely been supplanted by more effective or safer agents, include boric acid and volatile oils such as methyl salicylate (oil of wintergreen).

Chlorhexidine shows a high margin of safety when applied to mucous membranes, and has been used in oral rinses and preoperative total body washes.

Benzalkonium chloride and hexachlorophine are used primarily as hand scrubs or face washes. Benzalkonium may also find application as a disinfecting agent for instruments, and in low concentration as a preservative for drugs including ophthalmic solutions. Benzalkonium chloride is inactivated by organic compounds, including soap, and must not be applied to areas that have not been fully rinsed.

Iodine compounds include tincture of iodine and povidone iodine compounds. Iodine compounds have the broadest spectrum of all topical anti-infectives, with action against bacteria, fungi, viruses, spores, protozoa, and yeasts. Iodine tincture is highly effective, but its alcoholic component is drying and extremely irritating when applied to abraded (scraped or rubbed) skin. Povidone iodine, an organic compound, is less irritating and less toxic, but not as effective. Povidone iodine has been used for hand scrubs and disinfection of surgical sites. Aqueous solutions of iodine have also been used as antiseptic agents, but are less effective than alcoholic solutions and less convenient to use that the povidone iodine compounds.

Hydrogen peroxide acts through the liberation of oxygen gas. Although the antibacterial activity of hydrogen peroxide is relatively weak, the liberation of oxygen bubbles produces an effervescent action, which may be useful for wound cleansing through removal of tissue debris. The activity of hydrogen peroxide may be reduced by the presence of blood and pus. The appropriate concentration of hydrogen peroxide for antiseptic use is 3%, although higher concentrations are available.

Thimerosol (Mersol) is a mercury compound with activity against bacteria and yeasts. Prolonged use may result in mercury toxicity.


Recommended dosage

Dosage varies with product and intended use. Patients should ask a physician.


Precautions

Precautions vary with individual product and use.

Hypersensitivity reactions should be considered with organic compounds such as chlorhexidine, benzalkonium and hexachlorophine.

Skin dryness and irritation should be considered with all products, but particularly with those containing alcohol.

Systemic toxicity may result from ingestion of iodine-containing compounds or mercury compounds.

Most antiseptics have not been rated according to pregnancy category under the pregnancy risk factor system. Hexachlorophene is schedule C during pregnancy, and should not be used on newborns due to risk of systemic absorption with potential central nervous system (CNS) effects, including convulsions. Application of hexachlorophene to open wounds, mucous membranes, or areas of thin skin, such as the genitalia, should be avoided, since this may promote systemic absorption.

Chlorhexidine should not be instilled into the ear. There is one anecdotal report of deafness following use of chlorhexidine in a patient with a perforated eardrum. Safety in pregnancy and breastfeeding have not been reported; however there is one anecdotal report of an infant developing slowed heartbeat apparently related to maternal use of chlorhexidine.

Iodine compounds should be used sparingly during pregnancy and lactation due to risk of infant absorption of iodine with alterations in thyroid function.


Interactions

Antiseptics are not known to interact with any other medicines. However, they should not be used together with any other topical cream, solution, or ointment.


Resources

periodicals

Farley, Dixie. "Help for Cuts, Scrapes and Burns." FDA Consumer (May 1996): 12.

McDonnell, Gerald and A. Denver Russell. "Antiseptics and Disinfectants: Activity, Action, and Resistance." Clinical Microbiology Reviews Vol. 12, No. 1 (January 1999): 147–179. Also available at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88911 . [cited June 30, 2003].

Waldman, Hilary. "New ways to treat wounds; Doctors abandon failed conventions that focus on caring for bruises at the surface for methods that reach the source." Los Angeles Times (May 26, 2003).

Weber J. et al. "Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis ) from contaminated hands." Journal of the American Medical Association (Mar 12, 2003).

other

United States Department of Energy. "Antiseptics and Disinfectants." Ask A Scientist: Molecular Biology Archive. December 04, 2002 [cited June 29, 2003]. http://newton.dep.anl.gov/askasci/mole00/mole00361.htm .


Samuel Uretsky, PharmD

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