Povidone Iodine vs Chlorhexidine Gluconate for Preoperative Skin Antisepsis: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

BACKGROUND: Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG. METHOD: We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I2 statistics. FINDINGS: Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001). CONCLUSION: PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.

Rol de la Clorhexidina en sus Diferentes Formatos para la Prevención de la Alveolitis Seca: Revisión Sistemática Exploratoria

El objetivo de este estudio fue investigar el rol de la clorhexidina en sus diferentes formatos en la prevención de la alveolitis seca posterior a la extracción dental. Se realizó una búsqueda electrónica en las bases de datos de PubMed, Scopus, Web of Science. hasta el año 2021. Dos revisores de forma independiente realizaron el análisis de los artículos. La búsqueda inicial dio como resultado 192 artículos. Se descartaron 59 artículos duplicados y se realizó una revisión general inicial de títulos y resúmenes, verificando que se cumplan los criterios de inclusión y exclusión preestablecidos. De 192 estudios, 25 cumplieron con los criterios de inclusión. De los 25 artículos, 10 incluyeron pacientes con factores de riesgo asociados a alveolitis seca. Respecto al sitio de extracción dental, 19 artículos incluyeron pacientes con terceros molares mandibulares. Dentro de los artículos filtrados se utilizaron tres formatos de clorhexidina: enjuague, gel bioadhesivo e irrigante; estos en diferentes concentraciones, y comparadas con distintos grupos placebos. De los estudios incluidos, 18 informaron que la clorhexidina en sus diferentes formatos proporcionaba disminución en la incidencia de alveolitis seca versus el grupo control. El uso de clorhexidina en sus diferentes formatos después de la extracción dental es altamente efectivo en la prevención de la alveolitis seca. Sin embargo, inferimos que se necesitan nuevas líneas investigativas que incluyan pacientes con factores de riesgo asociados, y estudios que no utilicen terapias complementarias, puesto que, estos factores pueden conducir a confusión en los resultados obtenidos.

The objective of this study was to investigate the role of chlorhexidine in its different formats in the prevention of dry socket after dental extraction. The electronic search was performed using keywords and MeSH terms in the databases of PubMed, Scopus, Web of Science, until 2021. The reviewers independently performed the analysis of the articles. The initial search resulted in 192 articles. 59 duplicate articles were discarded, and an initial general review of titles and abstracts was performed, verifying that the pre-established inclusion and exclusion criteria were met. Of 192 studies, 25 met the inclusion criteria. Of the 25 articles, 10 included patients with risk factors associated with dry socket. Regarding the site of dental extraction, 19 articles included patients with mandibular third molars. Within the filtered articles, three formats of chlorhexidine were used: rinse, bioadhesive gel and irrigant, in different concentrations, and compared with different placebo groups. Of the included studies, 18 reported that chlorhexidine in its different formats provided a decrease in the incidence of dry socket versus the control group. The use of chlorhexidine in its different formats after dental extraction, is highly effective in preventing dry socket. However, we infer that new research lines are needed that include patients with associated risk factors, and studies that do not use complementary therapies.

In situ and in vitro evaluation of two antiseptics for blood bank based on chlorhexidine gluconate/isopropyl alcohol and povidone-iodine.

BACKGROUND: Poor disinfection is the main cause of blood contamination, so its elimination is key to limiting the entry of bacteria into the collection system. With the advancement of antiseptic technology, antiseptics with sterile, disposable applicators are now available. AIM: To evaluate in situ two antiseptics (with and without applicators) for blood banks and to demonstrate in vitro antiseptic activity on bacterial biofilms of importance in transfusion medicine. METHODS: Antiseptic A (2% sterile solution of chlorhexidine gluconate/70% isopropyl alcohol provided with applicator) and bulk antiseptic B (10% povidone-iodine) were evaluated. The deferred blood donor arms were subjected to disinfection with antiseptics A and B and the contralateral arms were cultured to determine the baseline bacterial load (control). Antiseptic activity was assessed by ANOVA and logaritmic reduction values (LRV) and percentage reduction values (PRV) were calculated. Finally, the in vitro activity of antiseptic A was analyzed by confocal laser scanning microscopy (CLSM) on biofilm models. RESULTS: Prior to disinfection tests, commensal and clinically important bacteria were identified; antiseptic A showed post-disinfection bacterial growth rates of zero compared to controls (p < 0.0001). The frequency of bacterial growth with antiseptic B was 74%. A significant difference was identified between both antiseptics, where antiseptic A showed higher activity (p < 0.5468). LRV and PRV were 0.6-2.5/100% and 0.3-1.7/66.7-99.7% for antiseptics A and B, respectively. Through CLSM, disinfectant A (without applicator) showed lower in vitro antiseptic activity on the tested biofilms at the exposure times recommended by the manufacturer. CONCLUSIONS: Sterile solution of chlorhexidine gluconate/isopropyl alcohol with applicator showed advantages disinfection in deferred blood donors over povidone-iodine.

Antimicrobial activity of Er, Cr: YSGG and Ultrasonic on E. faecalisbiofilm in the mesial root canal systems of lower molars / Atividade antimicrobiana de Er, Cr: YSGG e Ultrassônico no biofilme de E. faecalis nos sistemas de canais radiculares mesiais de molares inferiores

The internal topography of the root canal is complex, especially for the permanent molar's mesial root. In response to such issues, improved irrigation techniques have been created, which use laser pulses to agitate fluids and improve microbial deposit removal. Objective: To assess the effectiveness of the Er,Cr:YSGG laser with a wavelength of 2,780 nm via photon-induced photoacoustic streaming (PIPS) protocol which agitated of 2% chlorohexidine (CHX) in removing mature Enterococcus faecalis (E. faecalis) biofilm in root canal systems of lower molars. Material and Methods: The mesial roots of lower first and second molars were separated and inoculated with E. faecalis bacterial suspension for 30 days. The roots were irrigated with CHX, some of them were agitated with a passive ultrasonic device (PUI), while the other roots were agitated by an Er,Cr:YSGG laser in PIPS at 60 µs/pulse, 5 Hz, (0.25, 0.5, 0.75, and 1) W. An atomic force microscope (AFM) was used as a new method to get the results in the isthmus area; the obtained results from each group were compared with each other. Results: Based on the AFM and SEM analyses, laser and ultrasonic activation groups showed higher antimicrobial efficacy than the conventional syringe irrigation group (P<0.05). Conclusion: Based on the investigation's findings, the activation of 2% CHX solution by Er,Cr:YSGG laser in PIPS and PUI offers better mature bacterial biofilm removal in the mesial root of lower human molars than the same irrigant with the SI technique (AU)

A topografia interna do canal radicular é complexa, especialmente para a raiz mesial do molar permanente. Em resposta a esses problemas, foram criadas técnicas aprimoradas de irrigação, que utilizam pulsos de laser para agitar fluidos e melhorar a remoção de depósitos microbianos. Objetivo: Avaliar a eficácia do laser Er,Cr:YSGG com comprimento de onda de 2.780 nm via protocolo de streaming fotoacústico induzido por fótons (PIPS) que agitou clorohexidina a 2% (CHX) na remoção de Enterococcus faecalis maduro (E. faecalis) biofilme em sistemas de canais radiculares de molares inferiores. Material e Métodos: As raízes mesiais de 28 primeiros e segundos molares inferiores foram separadas e inoculadas com suspensão bacteriana de E. faecalis por 30 dias. As raízes foram irrigadas com CHX, sendo algumas delas agitadas com aparelho ultrassônico passivo (PUI), enquanto as demais raízes foram agitadas com laser Er,Cr:YSGG em PIPS a 60 µs/pulso, 5 Hz (0,25, 0,5, 0,75 e 1) W. Um microscópio de força atômica (AFM) foi utilizado como um novo método para obter os resultados na área do istmo; os resultados obtidos de cada grupo foram comparados entre si. Resultados: Com base nas análises de AFM e SEM, os grupos de ativação por laser e ultrassom apresentaram maior eficácia antimicrobiana do que o grupo de irrigação com seringa convencional (P<0.05). Conclusão: Com base nos achados da investigação, a ativação da solução de CHX a 2% pelo laser Er,Cr:YSGG em PIPS a (60 µs/pulso, 5 Hz, 0,75 W) oferece melhor remoção de biofilme (AU)

Evaluation of the Local Synergistic Effect of a Dexketoprofen and Chlorhexidine Combination in the Formalin Test.

OBJECTIVE: Evidence supports the local application of non-steroidal antiinflammatory drugs such as dexketoprofen trometamol (DXT) for pain management, but little is known about the potential antinociceptive effect of chlorhexidine gluconate (CHX) and its possible synergistic effect when combined with DXT. The aim of this study was to evaluate the local effect of a DXT-CHX combination using isobolographic analysis in a formalin pain model in rats. MATERIALS AND METHODS: Briefly, 60 female Wistar rats were used for the formalin test. Individual dose effect curves were obtained using linear regression. For each drug, the percentage of antinociception and median effective dose (ED50; 50% of antinociception) were calculated, and drug combinations were prepared using the ED50s for DXT (phase 2) and CHX (phase 1). The ED50 of the DXT-CHX combination was determined, and an isobolographic analysis was performed for both phases. RESULTS: The ED50 of local DXT was 5.3867 mg/mL in phase 2 and for CHX was 3.9233 mg/mL in phase 1. When the combination was evaluated, phase 1 showed an interaction index (II) of less than 1, indicating synergism but without statistical significance. For phase 2, the II was 0.3112, with a reduction of 68.88% in the amounts of both drugs to obtain the ED50; this interaction was statistically significant (P < .05). CONCLUSION: DXT and CHX had a local antinociceptive effect and exhibited synergistic behavior when combined in phase 2 of the formalin model.

Antibacterial Effect of Commercial Mouthwashes on Streptococcus mutans: an in vitro study / Efecto Antibacteriano de Colutorios Comerciales en la Proliferación de Streptococcus mutans: un Estudio in vitro

The aim of this study was to compare the antibacterial effect of eight different commercial (MWs) on two Streptococcus mutans (SM) strains by using the agar well diffusion method. Eight commercial MWs were selected, all of them combined several ingredients in different concentrations, the main active ingredients were: Chlorhexidine gluconate, cetylpyridinium chloride, sodium fluoride, zinc lactate, vitamin B5 and super-oxidized water. The SM strains were extracted from Cultiloops® and incubated for 24 hours at 37 °C. The antimicrobial activity was evaluated using the agar well diffusion method. The inhibition zones were measured using an electronic digital caliper. The R© software was used to perform the statistical analysis using Kruskall-Wallis test and Dunn's multiple comparisons test. Seven commercial formulas demonstrated inhibitory effect over both SM strains. Only the MW containing super-oxidized water did not exhibit antibacterial activity. Higher inhibitory effect was observed in the chlorhexidine gluconate formula (27.38 ± 0.98 mm and 31.52 ± 0.64 mm). No statistically significant differences were observed when comparing formulas containing chlorhexidine gluconate in combination with other active ingredients. Seven MWs showed antibacterial activity except super-oxidized water formula. MWs containing chlorhexidine gluconate demonstrated the best effect against SM. However, no statistically significant differences were found when comparing formulas using exclusively chlorhexidine gluconate or combined with other antiseptics. Future research must be performed, focused on developing new MWs with similar antibacterial effects to chlorhexidine, but free of side effects, particularly in long-term treatments.

El objetivo de este estudio fue comparar el efecto antibacteriano de ocho colutorios comerciales en la proliferación de dos cepas de Streptococcus mutans (SM) mediante el método de difusión de pozos de agar. Se seleccionaron ocho colutorios comerciales, todos ellos combinados con varios ingredientes en diferentes concentraciones, los principales ingredientes activos fueron: gluconato de clorhexidina, cloruro de cetilpiridinio, fluoruro de sodio, lactato de zinc, vitamina B5 y agua superoxidada. Las cepas SM se extrajeron de Cultiloops® y se incubaron durante 24 horas a 37 °C. La actividad antimicrobiana se evaluó mediante el método de difusión de placa de agar. Las zonas de inhibición se midieron utilizando un calibre digital electrónico. Se utilizó el software R © para realizar el análisis estadístico mediante la prueba de Kruskall-Wallis y la prueba de comparaciones múltiples de Dunn. Siete fórmulas comerciales demostraron efecto inhibidor sobre ambas cepas SM. Solo el colutorio que contenía agua superoxidada no mostró actividad antibacteriana. Se observó un mayor efecto inhibidor en las fórmulas congluconato de clorhexidina (27,38 ± 0,98 mm y 31,52 ± 0,64 mm). No se observaron diferencias estadísticamente significativas al comparar fórmulas que contienen gluconato de clorhexidina en combinación con otros ingredientes activos. Siete MW mostraron actividad antibacteriana excepto la fórmula de agua superoxidada. Los colutorios que contienen gluconato de clorhexidina mostraron el mejor efecto contra SM. Sin embargo, no se encontraron diferencias estadísticamente significativas al comparar fórmulas que combinaron con otros principios activos. Se deben realizar investigaciones, enfocadas en el desarrollo de nuevos colutorios con efectos antibacterianos similares a la clorhexidina, pero libres de efectos secundarios, particularmente en tratamientos a largo plazo.

Salivary SARS-CoV-2 load reduction with mouthwash use: A randomized pilot clinical trial.

The saliva of patients with COVID-19 has a high SARS-CoV-2 viral load. The risk of spreading the virus is high, and procedures for viral load reduction in the oral cavity are important. Little research to date has been performed on the effect of mouthwashes on the salivary SARS-CoV-2 viral load. This pilot randomized single-center clinical trial investigated whether three types of mouthwash with solutions containing either 0.075% cetylpyridinium chloride plus 0.28% zinc lactate (CPC + Zn), 1.5% hydrogen peroxide (HP), or 0.12% chlorhexidine gluconate (CHX) reduce the SARS-CoV-2 viral load in saliva at different time points. Sixty SARS-CoV-2-positive patients were recruited and randomly partitioned into a placebo (oral rinsing with distilled water) group and other groups according to the type of mouthwash. Saliva samples were collected from the participants before rinsing (T0), immediately after rinsing (T1), 30 min after rinsing (T2), and 60 min after rinsing (T3). The salivary SARS-CoV-2 viral load was measured by qRT-PCR assays. Rinsing with HP and CPC + Zn resulted in better reductions in viral load, with 15.8 ± 0.08- and 20.4 ± 3.7-fold reductions at T1, respectively. Although the CPC + Zn group maintained a 2.6 ± 0.1-fold reduction at T3, this trend was not observed for HP. HP mouthwash resulted in a significant reduction in the SARS-CoV-2 viral load up to 30 min after rinsing (6.5 ± 3.4). The CHX mouthwash significantly reduced the viral load at T1, T2, and T3 (2.1 ± 1.5-, 6.2 ± 3.8-, and 4.2 ± 2.4-fold reductions, respectively). In conclusion, mouthwash with CPC + Zinc and CHX resulted in significant reductions of the SARS-CoV-2 viral load in saliva up to 60 mins after rinsing, while HP mouthwash resulted in a significant reduction up to 30 mins after rinsing. Despite this transitory effect, these results encourage further studies and suggest that these products could be considered as risk-mitigation strategies for patients infected with SARS-CoV-2.

Use of chlorhexidine chip after scaling and root planning on periodontal disease: A systematic review and meta-analysis.

OBJECTIVE: This systematic review aims to assess the efficacy chlorhexidine chip as an adjunctive therapy of scaling and root planning on periodontal disease treatment. MATERIAL AND METHODS: This study follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO database (CRD42019148221). The search was performed in PubMed/MEDLINE, Scopus, and Cochrane databases until April 2020. The PICO question was: "Is the chlorhexidine chip (CHX) effective as an adjunctive therapy of scaling and root planning on periodontal disease treatment?". Inclusion criteria involved: randomized controlled clinical trials, with a minimum of 15 patients included on the sample and each patient has two sites of probing depth of ≥5 mm; The minimum follow up was at least 1 months of follow-up and the outcomes present in the studies probing depth (PD), plaque index (PI) and clinical attachment level (CAL) after scaling and root planning (SRP). RESULTS: After searching the databases, 13 articles were selected for qualitative and 8 for quantitative analysis. Were included 427 patients, with a mean age of 45.6 years. The results shown that the association of chlorhexidine chips to scaling and root planning reduce periodontal pocket depths (P < 0.00001; MD -0.77 [CI -1.0 to -0.55]; I2 = 23%, P = 0.24), gain on the clinical attachment level (P < 0.0001; MD -0.57 [CI -0.86 to -0.27]; I2 = 33%, P = 0.18P < 0.0001) and reduction on plaque index (P = 0.04; MD -0.23 [CI -0.45 to -0.01]; I2 = 91%, P < 0.00001). CONCLUSIONS: Thus, we can conclude that chlorhexidine chip when used associated to scaling and root planning promoted a significant improvement the reduction of periodontal diseases.

Antisepsys and profilatic antimicrobial therapy in prevention of surgical site infection of horses / Antissepsia e terapia antimicrobiana profilática no controle infeccioso do foco cirúrgico em equinos

The efficacy of an antisepsis protocol comprising chlorhexidine gluconate and ethyl alcohol in combination with prophylactic antimicrobial therapy in controlling surgical site infection in horses was studied. To that purpose, seven mixed breed horses received potassium penicillin and gentamicin at least 30 minutes prior to surgery. The surgical site was scrubbed with chlorhexidine gluconate and rinsed with ethyl alcohol. Samples were collected at four time points: (A) - before and (B) - immediately following shaving of the hair coat, (C) - at the end of antisepsis procedures, and (D) - at the end of the surgical procedure. Duration of surgery was recorded. Samples were cultured in three different culture mediums: Mitis Salivarus (Streptococcus sp.), Staphylococcus 110 (Staphylococcus sp.), and Mac Conkey (Enterobacteria). A high level of bacterial growth was observed in all culture mediums at (A) and (B), with no bacterial growth in (C). Staphylococcus sp. growth was observed in (D) in a single patient whose surgical procedure lasted for 120 minutes. Shaving of the hair coat reduced microbial flora on the surface of the skin. Antisepsis in combination with prophylactic antimicrobial therapy was effective in controlling surgical site infection in elective procedures with an average duration of 90 minutes.(AU)

Objetivou-se averiguar a eficácia do protocolo de antissepsia com clorexidina degermante e álcool etílico hidratado 70%, em associação com terapia antimicrobiana profilática, no controle microbiano do foco cirúrgico de equinos submetidos a procedimentos cirúrgicos. Foram utilizados 07 cavalos adultos de raças variadas, onde ambos receberam o mesmo tratamento (terapia antimicrobiana profilática e antissepsia com clorexidina degermante 2% e álcool etílico hidratado 70%), coletando-se amostras em quatro tempos distintos [(A - antes da tricotomia), (B - imediatamente após tricotomia), (C - ao término da antissepsia), (D - ao término do procedimento cirúrgico)]. O tempo de cada procedimento cirúrgico foi contabilizado. Foram utilizados três meios de cultura diferentes, cada um com especificidade para um tipo de crescimento bacteriano. Constatou-se alta incidência de crescimento bacteriano nos três meios utilizados nos tempos de coleta A e B. Para o tempo C, não foi observado crescimento bacteriano. No tempo D averiguou-se crescimento bacteriano do tipo Staphylococcus sp. em um único paciente, cujo tempo cirúrgico foi de 120 minutos de duração. Desta forma, a tricotomia reduziu a carga microbiana na superfície da pele. A antissepsia associada à terapia antimicrobiana profilática mostrou-se eficaz no controle microbiano do foco cirúrgico em procedimentos eletivos, com duração média de 90 minutos.(AU)

Antisepsys and profilatic antimicrobial therapy in prevention of surgical site infection of horses / [Antissepsia e terapia antimicrobiana profilática no controle infeccioso do foco cirúrgico em equinos

The efficacy of an antisepsis protocol comprising chlorhexidine gluconate and ethyl alcohol in combination with prophylactic antimicrobial therapy in controlling surgical site infection in horses was studied. To that purpose, seven mixed breed horses received potassium penicillin and gentamicin at least 30 minutes prior to surgery. The surgical site was scrubbed with chlorhexidine gluconate and rinsed with ethyl alcohol. Samples were collected at four time points: (A) - before and (B) - immediately following shaving of the hair coat, (C) - at the end of antisepsis procedures, and (D) - at the end of the surgical procedure. Duration of surgery was recorded. Samples were cultured in three different culture mediums: Mitis Salivarus (Streptococcus sp.), Staphylococcus 110 (Staphylococcus sp.), and Mac Conkey (Enterobacteria). A high level of bacterial growth was observed in all culture mediums at (A) and (B), with no bacterial growth in (C). Staphylococcus sp. growth was observed in (D) in a single patient whose surgical procedure lasted for 120 minutes. Shaving of the hair coat reduced microbial flora on the surface of the skin. Antisepsis in combination with prophylactic antimicrobial therapy was effective in controlling surgical site infection in elective procedures with an average duration of 90 minutes.(AU)

Objetivou-se averiguar a eficácia do protocolo de antissepsia com clorexidina degermante e álcool etílico hidratado 70%, em associação com terapia antimicrobiana profilática, no controle microbiano do foco cirúrgico de equinos submetidos a procedimentos cirúrgicos. Foram utilizados 07 cavalos adultos de raças variadas, onde ambos receberam o mesmo tratamento (terapia antimicrobiana profilática e antissepsia com clorexidina degermante 2% e álcool etílico hidratado 70%), coletando-se amostras em quatro tempos distintos [(A - antes da tricotomia), (B - imediatamente após tricotomia), (C - ao término da antissepsia), (D - ao término do procedimento cirúrgico)]. O tempo de cada procedimento cirúrgico foi contabilizado. Foram utilizados três meios de cultura diferentes, cada um com especificidade para um tipo de crescimento bacteriano. Constatou-se alta incidência de crescimento bacteriano nos três meios utilizados nos tempos de coleta A e B. Para o tempo C, não foi observado crescimento bacteriano. No tempo D averiguou-se crescimento bacteriano do tipo Staphylococcus sp. em um único paciente, cujo tempo cirúrgico foi de 120 minutos de duração. Desta forma, a tricotomia reduziu a carga microbiana na superfície da pele. A antissepsia associada à terapia antimicrobiana profilática mostrou-se eficaz no controle microbiano do foco cirúrgico em procedimentos eletivos, com duração média de 90 minutos.(AU)

Control of bacterial and fungal biofilms by natural products of Ziziphus joazeiro Mart. (Rhamnaceae).

The aim of this study is to verify the action of the aqueous leaf extract Ziziphus joazeiro in the eradication of bacterial and fungal biofilms, and to compare these effects with the stem bark extracts, as well as with conventional standard drugs. The presence of secondary metabolites was observed through phytochemical prospection assays. The effect of the aqueous extract on microbial biofilm formation was observed by OD600 nm absorbance and the crystal violet assay. For bacterial and fungal biofilms, chlorhexidine gluconate and fluconazole, respectively, were used as positive controls. Phytochemical characterization showed the presence of secondary metabolite classes common to both extracts such as flavonoids, steroids and saponins. In particular, in the aqueous leaf extract phenols, condensed tannins and alkaloids were observed. Eradication results using the aqueous leaf extract showed an inhibition of the microbial biofilm mass, moreover the biofilms were more sensitive to the bark extract, which presented a greater inhibition number and an action similar to standard drugs. It is important to highlight the leaf extract showed significant eradication at the lowest concentrations for mature yeast biofilms, thus demonstrating its potential to modify microbial resistance susceptibility. Bacterial and fungal biofilm eradication results using the Ziziphus joazeiro aqueous extracts presented a biofilm inhibition effect for both, moreover the results support the ethnopharmacological knowledge surrounding the use of Ziziphus joazeiro stems in the community. In comparison, the bark extract presented a more effective treatment than the leaf extract against biofilms, presenting inhibition levels similar to the used standard drugs.

Chlorhexidine-Induced Chemical Burns in Very Low Birth Weight Infants.

Skin disinfection with chlorhexidine gluconate has not been standardized in preterm infants. We present 5 cases of chemical burns that occurred within the first 2 days of life in very low birth weight neonates after skin disinfection with aqueous and alcohol-based chlorhexidine solutions.

Differential effects of the combination of tyrosol with chlorhexidine gluconate on oral biofilms.

OBJECTIVE: This study assessed the effect of tyrosol and chlorhexidine gluconate in combination against Candida albicans, Candida glabrata, and Streptococcus mutans in the planktonic state or forming biofilms in vitro. MATERIALS AND METHODS: Checkerboard assays were performed for determination of minimum inhibitory concentration. Biofilms were cultivated during 24 h on specimens of acrylic resin and hydroxyapatite and treated with the drugs alone or in combination twice a day for 1 min, during 3 days. The antibiofilm effect was determined by quantification of the metabolic activity and cultivable cells. The drug combination was also applied on C. albicans to investigate its action on the number of hyphae. Data were statistically examined by two-way ANOVA and Holm-Sidak test (P < 0.05). RESULTS: The effect of drug combination on planktonic cells was classified as antagonistic for C. albicans and indifferent for the other strains. Also, the drugs were ineffective against the tested biofilms. However, the drug combination showed a synergistic effect in reducing the number of hyphae by C. albicans. CONCLUSION: The combination of tyrosol with chlorhexidine gluconate was only effective in reducing the number of hyphae by C. albicans, a relevant virulence factor of this species.

Influência da clorexidina na resistência de união longitudinal à dentina: estudo in vitro / Influence of chlorhexidine on longitudinal bond strength to dentin: in vitro study

Objetivo: Este estudo avaliou o efeito da solução de gluconato de clorexidina 0,2% (CHX) usado como primer terapêutico sobre a resistência de união longitudinal de adesivo convencional a dentina. Material e Métodos: dentes bovinos foram desgastados para obter uma área de dentina, e foram divididos em 2 grupos: Grupo C (Controle) - ácido fosfórico à 37%) + 0,2% CHX por 30s + Single Bond. Blocos de resina composta form fabricados e armazenados por 24 h e 6 meses, seccionados e submetidos ao teste de resistência a microtração. Os resultados foram analisados por ANOVA dois-fatores seguido pelo teste de Tukey. Resultados: Valores de média (±Desvio-padrão) (MPa): Grupo CHX/24h - 41,8(±2,62)A; Grupo C/24h - 40,8(±3,35)AB; Grupo CHX/6 meses ­ 36,4(±3,52)B; Grupo CHX/6 meses - 26,1(±1,54) C. Resultados: Valores de média (±Desvio-padrão) (MPa): CHX (24 h) ­ 41,76 (±2,62)a; C (24h) ­ 40,81 (±3,35)ab; GT (24h): 37,38(2,98)abc; CHX (6 meses) ­ 36,04 (±3,52) bcd; EGCG (24h) ­ 35,91 (±4,82)cd; EGCG (6 meses) ­ 35,75 (±4,44)cd; GT (6 meses) ­ 31,95 (±3,40)de; C (6 meses): 30,05 (±1,54)e. Conclusão: CHX aumentou a resistência de união imediata da interface dentina-resina e significantemente reduziu a perda de resistência de união após 6 meses de armazenagem em água quando comparado ao grupo controle.(AU)

Objective: This study evaluated the effect of 0.2% chlorhexidine gluconate solution used as an therapeutic primer on the long-term bond strength of etch-and-rinse adhesive to dentin. Material and Methods: Bovine incisors were worn to expose an area of dentin and were divided into 2 groups: Group C (Control) - acid etching with 37% phosphoric acid + Single Bond; Group CHX (0.2% CHX) - acid etching with 37% phosphoric acid + 0.2% CHX for 30 s + Single Bond. Blocks of composite were fabricated and stored for 24 h or 6 months, sectioned into beams and submitted to microtensile tests. Results were analyzed by two-way ANOVA and Tukey tests. Results: Mean (±SD) values (in MPa) were as follow: Group CHX/24h - 41.8(±2.62)A; Group C/24h - 40.8(±3.35)AB; Group CHX/6 months ­ 36.4(±3.52)B; Group CHX/6 months - 26.1(±1.54)C. Conclusion: CHX improve the imediatte bond strength of resin-dentin and significantly lowered the loss of bond strength after 6 months water storage as seen in the control bonds.(AU)

Antimicrobial activity of different disinfectants against cariogenic microorganisms

Abstract The aim of this study was to assess the in vitro antimicrobial effects of chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHBM), and octenidine dihydrochloride (OCT) on cariogenic microorganisms by using their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). CHX, PHBM, and OCT were diluted in distilled water to the final test concentrations. Using the in-tube dilution method, Streptococcus mutans, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Actinomyces viscosus were cultivated on blood agar and Mueller-Hinton broth (MHB) at 37°C for 48 h. They were read using a spectrophotometer to detect MIC. To determine MBC, samples in the range of the turbidity threshold after 24 h were transferred onto blood agar and evaluated for growth after 24 h. Different MICs and MBCs were observed in all disinfectants against each microorganism. The lowest MIC and MBC against S. mutans (60 mg/L) were obtained from PHBM. The lowest values against L. rhamnosus (15 mg/L, 30 mg/L), A. viscosus (30 mg/L), and L. acidophilus (15 mg/L, 30 mg/L) were determined by OCT. PHBM and OCT have the potential to be replaced with CHX because they were effective against cariogenic microorganisms.

Effect of chlorhexidine, green tea and egcg as therapeutic primers to increase the durability of resin-dentin bond / Efeito da clorexidina, do chá verde e do EGCG como primers terapêuticos para aumentar a durabilidade da adesão resinadentina

Objetivo: este estudo avaliou o efeito da solução de gluconato de clorexidina 0,2% (CHX), do chá verde e do componente ativo epigallocatequina 3-gallato (gel de EGCG) usados como primers terapêuticos sobre a resistência de união longitudinal de adesivo convencional a dentina. Material e Métodos: oitenta dentes bovinos foram desgastados para obter uma área de dentina plana, que foi condicionada (ácido fosfórico à 37%) seguida de lavagem. Os dentes foram divididos em 4 grupos (n- 20): Grupo C (Controle) - Single Bond; Grupo CHX – 0,2% CHX por 30s + Single Bond; Grupo EGCG - gel de EGCG 10µM por 30s + Single Bond; Group GT – chá verde aquoso por 30s + Single Bond. Blocos de resina composta form fabricados e armazenados por 24 h e 6 meses, seccionados e submetidos ao teste de resistência a microtração. Os resultados foram analisados por ANOVA dois-fatores seguido pelo teste de Tukey. Resultados: Valores de média (±Desvio-padrão) (MPa): CHX (24 h) – 41,76 (±2,62)a; C (24 h) – 40,81 (±3,35)ab; GT (24h): 37,38(2,98)abc; CHX (6 meses) – 36,04 (±3,52) bcd; EGCG (24h) – 35,91 (±4,82)cd; EGCG (6 meses) – 35,75 (±4,44)cd; GT (6 meses) – 31,95 (±3,40)de; C (6 meses): 30,05 (±1,54)e. Conclusão: O gel de EGCG produziu uma interface adesiva dentina-resina que não alterou os valores de resistência de união após 6 meses de armazenagem em água, mas reduziu a resistência de união para o tempo de 24 h quando comparado com os grupos Controle e CHX.

Objective: This study evaluated the effect of 0.2% chlorhexidine gluconate solution (CHX), green tea and active epigallocatechin-gallate (EGCG) used as therapeutic primers on the longterm bond strength of etch-and-rinse adhesive to dentin. Material and Methods: Eighty bovine incisors were worn to expose an area of dentin, that were acid-etched (37% phosphoric acid) and rinsed. The teeth were divided into 4 groups (n = 20): Group C (Control) - Single Bond; Group CHX - 0.2% CHX for 30s + Single Bond; Group EGCG - active EGCG gel at 10 µM for 30 s + Single Bond; Group GT - aqueous green tea for 30s + Single Bond. Blocks of composite were fabricated and stored for 24 h or 6 months, sectioned into beams and submitted to microtensile tests. Results were analyzed by two-way ANOVA and Tukey’s test (5%). Results: Mean (±SD) values (in MPa) were as follow: CHX (24 h) – 41.76 (±2.62); C (24 h) - 40.81 (±3.35); GT (24 h): 37.38(2.98); CHX (6 months) - 36.04 (±3.52); EGCG (24h) - 35.91 (±4.82); EGCG (6 months) - 35.75 (±4.44); GT (6 months) - 31.95 (±3.40); C (6 months): 30.05 (±1.54). Conclusion: EGCG produced resin-dentin bonds that did not change after 6 months water storage but it decreased the immediate bond strength when compared to control and chlorhexidine groups

Candida albicans adherence to denture base material: chemical disinfection and the effect of acquired salivary pellicle formation.

PURPOSE: The aim of this study was to evaluate the effect of 1% sodium hypochlorite (H1%) and 4% chlorhexidine gluconate (CG4%) on the adhesion of Candida albicans to denture base acrylic resins, as well as to verify the effect of the acquired salivary pellicle (ASP) formation on this process. MATERIALS AND METHODS: A total of 300 acrylic specimens were immersed in distilled water (control) (n = 100), H1% (n = 100), or CG4% (n = 100) for 30 days. Twenty specimens were used in each experimental period (0, 1, 7, 15, 30 days). At the end of disinfection testing periods, 10 specimens of each group were exposed to human whole saliva to simulate ASP formation, and then all specimens were incubated with C. albicans ATTC 90028. Microorganism adhesion was analyzed by fluorescence microscopy, after staining with Acridine orange. RESULTS: In the 30(th) disinfection cycle in relation to baseline, the H1% or CG4%, without ASP formation, reduced the C. albicans adhesion by approximately 80%; however, with ASP, this reduction after disinfection with H1% was higher (88%). The presence of ASP resulted in higher reduction of adhered fungal cells in comparison to resin without ASP, at the 1(st) H1% or CG4% disinfection cycle, as well as at 30(th) H1% disinfection cycles. CONCLUSIONS: Our results suggest that the presence of saliva might influence the adhesion of C. albicans and improve the effectiveness of methods to reduce fungal adhesion.

Preparation and evaluation of antimicrobial activity of nanosystems for the control of oral pathogens Streptococcus mutans and Candida albicans.

BACKGROUND: Diseases that affect the buccal cavity are a public health concern nowadays. Chlorhexidine and nystatin are the most commonly used drugs for the control of buccal affections. In the search for more effective antimicrobials, nanotechnology can be successfully used to improve the physical chemical properties of drugs whilst avoiding the undesirable side effects associated with its use. Herein described are studies using nystatin and chlorhexidine with sodium montmorillonite (MMTNa), and chlorhexidine with ß-cyclodextrin and two derivatives methyl-ß-cyclodextrin and hydroxypropyl-ß-cyclodextrin in the development of antimicrobial nanosystems. METHODS: The nanosystems were prepared by kneading and solubilization followed by freeze-drying technique. The nanosystems were characterized by X-ray powder diffraction (XRPD), differential scanning calorimetry (DSC), and Fourier transform infrared spectroscopy (FTIR). Nanosystem antimicrobial activity against Streptococcus mutans and Candida albicans strains was evaluated with inhibition halo analysis. RESULTS: The nanocarriers MMTNa and cyclodextrins showed good yields. XRPD, FTIR, and DSC analysis confirmed the proposed nanosystems formation and the suitability of the production methods. The nanosystems that showed best antimicrobial effect were chlorhexidine gluconate (CHX) and cyclodextrin inclusion complexes and CHX:MMTNa 60% cation exchange capacity - 24 hours. CONCLUSION: The nanosystem formulations present higher stability for all chlorhexidine inclusion complexes compared with pure chlorhexidine. The nystatin nanosystems have the potential to mask the bitter taste, justifying subsequent in-vivo studies. For these reasons, further studies are being carried out to evaluate their application in professional formulations.

Efficacy of a chlorhexidine-gluconate impregnated patch for prevention of catheter-related infections in pediatric patients: systematic review and meta-analysis

Background. Nosocomial infections are risk factors related to intrahospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, the central venous catheter (CVC) is one of the most frequently related device-associated bloodstream infections. The aim of this study was to evaluate the efficacy and safety of a chlorhexidine-gluconate impregnated patch (CHGp) in reducing infections related to CVC in pediatric patients. Methods. We conducted a systematic review and meta-analysis. An electronic search of the literature (Medline, EMBASE, Lilacs and the Cochrane Library Plus) from 1966 to December 2010 was carried out for clinical trials comparing the CHGp vs. standard case management for prevention of catheter tip colonization (CTC); bloodstream infections (BSI) were retrieved. Results. Only two clinical trials were found with a total of 850 participants. Patients randomized to the CHGp group showed a lower incidence of CTC than the control group (14% vs. 25%), relative risk [RR]: 0.61, 95% confidence interval [CI 95% (0.45, 0.81)], p = 0.001), with a number needed to treat of 11. BSI showed a RR: 1.14, ([CI 95% (0.57, 2.28)], p = 0.71). Adverse events were found mainly in the CHGp group and were described as local skin reactions in 5.6% (RR 8.17 [95% CI: 1.19-56.14], p = 0.04). Local necrosis was present in only two infants of very low birth weight (0.48%). Conclusions. This meta-analysis demonstrated that the chlorhexidine-gluconate impregnated patch is effective in reducing CVC-related infections in the pediatric population. Serious adverse events are rare.

Preparation and evaluation of lidocaine hydrochloride in cyclodextrin inclusion complexes for development of stable gel in association with chlorhexidine gluconate for urogenital use.

Inclusions of lidocaine hydrochloride in cyclodextrins were prepared to obtain stable complexes compatible for association with chlorhexidine in a new gel formulation for use in urogenital applications. Two cyclodextrins, ß-cyclodextrin and methyl-ß-cyclodextrin, were used for encapsulating lidocaine hydrochloride through solubilization and kneading techniques. The lidocaine-cyclodextrin complexes were characterized by ultraviolet spectroscopy, Fourier transform infrared spectroscopy, differential scanning calorimetry, and X-ray diffraction. The results revealed that the techniques generated good yields of inclusion products that maintained the functional properties of lidocaine. In addition, the inclusion products obtained improved the compatibility of lidocaine hydrochloride with chlorhexidine in solution and a gel formulation. The gel formulation displayed desirable rheological and physicochemical properties. The results presented here are the first description of the inclusion of lidocaine with cyclodextrins, which improves compatibility with chlorhexidine in formulations for simultaneous delivery.