Chlorhexidine is widely used as an antiseptic and disinfectant in medical and nonmedical environments. Although the sensitization rate seems to be low, its ubiquitous use raises the possibility of sensitization in many patients and medical care workers. We describe a patient with anaphylaxis during digital rectal examination with chlorhexidine jelly. Urticaria, angioedema, dyspnea, and hypotension developed within a few minutes of the rectal examination. The patient fully recovered after treatment with epinephrine and corticosteroids. Skin tests for chlorhexidine were undertaken 5 weeks later, showing positive prick and intradermal skin tests. Within 30 min of the skin test, the patient complained of febrile sensation, chest tightness, angioedema, and urticaria on the face and trunk. An enzyme allergosorbent test for latex was negative. We present this case to alert clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. We suggest that chlorhexidine should be recognized as a causative agent of anaphylaxis during procedural interventions.
Administration, Topical ; Adrenal Cortex Hormones/administration & dosage ; Anaphylaxis/*chemically induced/drug therapy ; Anti-Infective Agents, Local/administration & dosage/*adverse effects ; Chlorhexidine/administration & dosage/*adverse effects ; *Digital Rectal Examination ; Epinephrine/administration & dosage ; Humans ; Male ; Middle Aged ; Sympathomimetics/administration & dosage

INTRODUCTIONThe surgeon uses different methods of surgical hand antisepsis with the aim of reducing surgical site infections. To date, there are no local studies comparing the efficacy of iodine hand scrub against newer alcohol-based hand rubs with active ingredients. Our pilot study compares a traditional aqueous hand scrub using 7.5% Povidone iodine (PVP-I) against a hand rub using Avagard: 61% ethyl alcohol, 1% chlorhexidine gluconate. The outcome measure is the number of Colony Forming Units (CFU) cultured from 10-digit fingertip imprints on agar plates.

MATERIALS AND METHODSTen volunteers underwent 2 hand preparation protocols, with a 30-minute interval in between-Protocol A (3-minute of aqueous scrub using PVP-I) and Protocol B (3-minute of hand rub, until dry, using Avagard). In each protocol, fingertip imprints were obtained immediately after hand preparation (t(0)). The volunteers proceeded to don sterile gloves and performed specific tasks (suturing). At one hour, the gloves were removed and a second set of imprints was obtained (t(1)).

RESULTSFour sets of fingertip imprints were obtained. All 10 participants complied with the supervised hand preparation procedures for each protocol. CFUs of initial fingertip imprints (t(0)): The median CFU counts for initial imprint was significantly higher in the PVP-I treatment (median = 6, Inter Quartile Range (IQR) = 33) compared to the Avagard treatment (median = 0, IQR = 0, P <0.001). CFUs of fingertip imprint at 1 hour (t(1)): The median CFU counts for second imprint (t(1)) was significantly higher in the PVP-I treatment (median = 0.5, IQR = 11) compared to the Avagard treatment (median = 0, IQR = 0, P = 0.009). Our results suggest that the Avagard was more efficacious than aqueous PVP-I scrub at reducing baseline colony counts and sustaining this antisepsis effect.

CONCLUSIONAlcohol hand rub with an active compound, demonstrated superior efficacy in CFU reduction. Based on our results, and those pooled from other authors, we suggest that alcohol-based hand rubs could be included in the operating theatre as an alternative to traditional surgical scrub for surgical hand antisepsis.

Alcohols ; administration & dosage ; Anti-Infective Agents, Local ; administration & dosage ; Antisepsis ; methods ; Chlorhexidine ; administration & dosage ; analogs & derivatives ; Cohort Studies ; Hand ; microbiology ; Hand Disinfection ; methods ; Humans ; Pilot Projects ; Povidone-Iodine ; administration & dosage ; Singapore

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative in nebulizer solutions, and can cause paradoxical onchoconstriction following nebulizing therapy in some asthmatics. We describe a case of anaphylactic shock in a 23-yr-old asthmatic woman following an intradermal skin test with a salbutamol solution containing BAC. Since she complained of cough and dyspnea after inhalation therapy with a nebulizer solution, we conducted an intradermal skin test using the same solution, which contained BAC. About 10 min later, the patient reported dizziness, palpitations, and dyspnea. On examination, tachycardia, tachypnea, and hypotension were found. She was resuscitated with a subcutaneous injection of epinephrine and an infusion of saline. One month later, we conducted a bronchial provocation test with BAC, and she showed a positive response.
Adult ; Anaphylaxis/*chemically induced ; Anti-Asthmatic Agents/administration & dosage ; Anti-Infective Agents, Local/*adverse effects ; Asthma/*drug therapy ; Benzalkonium Compounds/*adverse effects ; Female ; Human ; Nebulizers and Vaporizers ; Support, Non-U.S. Gov't

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among the pathogen of nosocomial infection, because it is resistant to most antibiotics except vancomycin and local treatment with most antiseptics are not effective to eradicate MRSA from the infected wounds. There is increasing fear that MRSA infection can be spread widely in the hospitals. The effectiveness of Gentian Violet against MRSA was reported by Saji et al in 1992 for the first time. We tried Gentian Violet dressing on MRSA infected wounds to evaluate whether at not the Gentian Violet is effective to eradicate 11RSA which existed in the open wound. METHODS: 24 patients were treated by wet dressing with 0.1%Gentian Violet soaked gauze twice daily. They included 10 cases of sacral and trochanteric pressure sore, 6 cases of postoperative wound infectious, 3 cases of posttraumatic skin defects, 2 cases of DM foot, 1 case of post infectious skin defect and 2 cases of electrical burn, The wound culture was evaluated for elimination of MRSA infection twice weekly. RESULTS: The clinical results revealed that MRSA was not detected in all cases within 34days (average 13.5 days) after topical administration 0.1% Gentian Violet. CONCLUSION: There is no evidence of tissue irritation with Gentian Violet dressing on open wound or wound margin. After negative conversion of MRSA with Gentian Violet dressing, gram (-) organism was isolated in a half of the cases. 0.1% Gentian Violet topical administration is a useful treatment method of wound infection with MRSA.
Administration, Topical ; Anti-Bacterial Agents ; Anti-Infective Agents, Local ; Bandages* ; Burns ; Cross Infection ; Femur ; Foot ; Gentian Violet* ; Gentiana* ; Humans ; Methicillin-Resistant Staphylococcus aureus* ; Pressure Ulcer ; Skin ; Vancomycin ; Viola ; Wound Infection* ; Wounds and Injuries*

OBJECTIVETo prepare the controlled-release delivery gutta-percha points containing metronidazole compound (CDGMC) and to determine its release rate in vitro.

METHODSThe drug points were made by using compound drugs and gutta-percha as a carrier, and CDGMC were prepared followed by enveloping a release membrane outward. The best formula was selected according to the release parameters of the drugs extracted in the release experiments in vitro. The CDGMC were placed into the extracted teeth after root canals were routinely prepared. The non-drug CDGMC was used as the control. The absorbency of the drugs in normal saline (37 degrees C, pH 7.4) was determined timely. The percentage of release and cumulated release of the drugs were calculated according to the concentrations of drugs in medium.

RESULTSThe in vitro experiments showed that this system contained 1,880 micrograms of metronidazole and 267 micrograms of ciprofloxacin. The experiments in healthy single root canal showed that the drug release amounts around the perioapical area were metronidazole 88.54 micrograms/ml and ciprofloxacin 9.05 micrograms/ml in 10 days.

CONCLUSIONCDGMC can continuously release effective drug concentrations more than 10 days and could be considered as an ideal method for clinical application.

Anti-Infective Agents, Local ; administration & dosage ; pharmacokinetics ; Ciprofloxacin ; administration & dosage ; pharmacokinetics ; Delayed-Action Preparations ; chemical synthesis ; pharmacokinetics ; Dental Pulp Cavity ; drug effects ; metabolism ; Drug Delivery Systems ; Gutta-Percha ; Humans ; Metronidazole ; administration & dosage ; pharmacokinetics ; Root Canal Therapy ; methods

ObjectiveTo study the influence of povidone-iodine (PI) versus that of the benzethonium chloride wipe (BCW) on semen collection and semen quality of sperm donors undergoing penile skin disinfection and provide some evidence for the selection of disinfection methods for semen collection.

METHODSWe used PI from August to December 2015 and BCWs from January to July 2016 for penile skin disinfection before semen collection, with two samples from each donor, one collected with and the other without penis skin disinfection (the blank control group). After semen collection, we conducted a questionnaire investigation on the influence of the two disinfection methods on semen collection and compared the semen parameters between the two groups of sperm donors.

RESULTSTotally, 185 sperm donors were included in this study, of whom 63 underwent penile skin disinfection with PI and the other 122 with BCWs before semen collection. Statistically significant differences were found between the PI and BCW groups in the adaptability to the disinfectant and rigid disinfection procedures (P <0.05), but not in the other items of the questionnaire (P >0.05). Compared with the sperm donors of the blank control group, those of the PI group showed statistically significant difference in the percentage of progressively motile sperm (PMS) (［63.02 ± 3.18］% vs ［61.45 ± 4.78］%, P<0.05), but not in the abstinence time (［4.97 ± 1.79］ vs ［4.7 ± 0.94］ d, P >0.05), semen volume (［4.11 ± 1.54］ vs ［4.15 ± 1.61］ ml, P >0.05), sperm concentration (［110 ± 29.6］ vs ［107.5 ± 31.79］ ×10⁶/ml, P >0.05), or total sperm count (［439.10 ± 170.13］ vs ［434.02 ± 186.91］ ×106/ejaculate, P >0.05), while those of the BCW group exhibited no remarkable difference in any of the above parameters (P >0.05). Among the samples with abnormal semen quality, significantly fewer were found with abnormal PMS in the BCW than in the PI group (1.64% ［2/122］ vs 9.68% ［6/62］, P <0.05). However, there were no significant differences between the PI and BCW groups in the abnormal semen volume, abnormal sperm concentration, or the rate of semen bacterial contamination (P >0.05).

CONCLUSIONSBefore semen collection from donors, penile skin disinfection with povidone-iodine may affect both the semen collection process and the quality of donor sperm, while the benzethonium chloride wipe can reduce the influence on the semen collection process and does not affect the semen parameters.

Anti-Infective Agents, Local ; administration & dosage ; Benzethonium ; administration & dosage ; Disinfection ; methods ; statistics & numerical data ; Humans ; Male ; Penis ; Povidone-Iodine ; administration & dosage ; Semen ; Semen Analysis ; Skin ; Sperm Count ; Sperm Retrieval ; Spermatozoa ; Tissue Donors

OBJECTIVETo evaluate the inhibitory effects of topical application of specific immunoglobulin yolk antibodies (IgY) to mutans streptococci on composition of human dental plaque.

METHODSA total of 24 healthy adult volunteers were selected and randomly distributed into three experimental groups. After a supragingival scaling, the subjects were treated with an application of IgY containing spray (test group, n = 9), a 0.15% chlorhexidine(CH) spray(positive control group, n = 9) or a placebo phosphate buffered saline(PBS) spray without any active ingredients(negative control group, n = 6) three times daily for three weeks. Pooled plaque samples from the smooth surfaces of teeth were collected for microbiologic analysis before administration (baseline, day 0), during treatment(days 7, 14 and 21) and after withdrawal of the agents(days 28, 42 and 56) and plaque index were recorded. Microbial cultivation were performed by serially diluting the samples with PBS solution an cultivating the aliquots on mitis salivarius agar(MS) and MS supplemented with bacitracin (MSB) for oral streptococci and mutans streptococci respectively. The number of colony-forming unit (CFU) per plate was counted and the percentage of mutans streptococci per oral streptococci in dental plaque were determined. The effect of IgY on colonization of mutans streptococci were analyzed by an analysis of variance (ANOVA).

RESULTSThe plaque indexes remained unchanged, but mutans streptococci in dental plaque was suppressed significantly following a short term(three weeks) application of IgY, and low level of mutans streptococci persisted for at least 5 weeks after withdrawal of IgY.

CONCLUSIONThe results suggest that the immunization with specific immunoglobulin yolk against mutans streptococci could be useful for long term suppression of mutans streptococci colonization in human dental plaque.

Adult ; Animals ; Anti-Infective Agents, Local ; administration & dosage ; Chickens ; Chlorhexidine ; administration & dosage ; Colony Count, Microbial ; Dental Caries ; prevention & control ; Dental Plaque ; microbiology ; Humans ; Immunoglobulins ; pharmacology ; Mouth ; microbiology ; Mouthwashes ; Streptococcus mutans ; drug effects ; isolation & purification

Effective final irrigation regimen is an important step in order to achieve better disinfection and ensure residual antimicrobial effects after root canal preparation. The aim of this study was to compare the residual antimicrobial activity of 0.2% cetrimide, and 0.2% and 2% chlorhexidine in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown on uniradicular roots for 4 weeks. After root canal preparation, root canals were irrigated with 17% ethylenediaminetetraacetic acid (EDTA) to remove the smear layer. The roots were randomly divided into three experimental groups (n=26) according to the final irrigating solution: Group I, 5 mL 0.2% cetrimide; Group II, 5 mL 0.2% chlorhexidine; and Group III, 5 mL 2% chlorhexidine. Samples were collected for 50 days to denote the presence of bacterial growth. The proportion of ungrown specimens over 50 days was evaluated using the nonparametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test and the level of statistical significance was set at P<0.05. The highest survival value was found with 2% chlorhexidine, showing statistically significant differences from the other two groups. At 50 days, E. faecalis growth was detected in 69.23% specimens in Groups I and II, and in 34.61% specimens of Group III. There were no significant differences between 0.2% cetrimide and 0.2% chlorhexidine. Final irrigation with 2% chlorhexidine showed greater residual activity than 0.2% chlorhexidine and 0.2% cetrimide in root canals infected with E. faecalis.
Anti-Infective Agents, Local ; administration & dosage ; therapeutic use ; Bacterial Load ; drug effects ; Biofilms ; drug effects ; Cetrimonium Compounds ; therapeutic use ; Chlorhexidine ; administration & dosage ; therapeutic use ; Dental Pulp Cavity ; microbiology ; Edetic Acid ; therapeutic use ; Enterococcus faecalis ; drug effects ; Gram-Positive Bacterial Infections ; drug therapy ; Humans ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; administration & dosage ; therapeutic use ; Root Canal Preparation ; methods ; Smear Layer ; Time Factors

OBJECTIVETo investigate the effect of 2-phenoxyethanol on potency of Sabin inactivated poliomyelitis vaccine (IPV).

METHODSSabin IPV samples containing 5 mg or 7 mg 2-phenoxyethanol each dosage respectively were placed separately at 4 degrees C, 37 degrees C for 2 days and 7 days. D-antigen contents were tested with ELISA method. Then neutralizing antibodies in mice and guinea pigs were detected. The safety experiment was performed according to unusual toxicity test of China requirement for biological product.

RESULTSAfter addition of 2-phenoxyethanol, the I, II, and III D-antigen contents of Sabin IPV did not change. The antibody levels in mice and guinea pigs were not different between experimental group and control group. Animals were safe during observation period.

CONCLUSION2-Phenoxyethanol had no effect on potency and safety of Sabin IPV. It can be used as antiseptic for Sabin IPV.

Animals ; Anti-Infective Agents, Local ; administration & dosage ; pharmacology ; toxicity ; Antigens, Viral ; analysis ; immunology ; Body Weight ; drug effects ; Cercopithecus aethiops ; Drug Stability ; Enzyme-Linked Immunosorbent Assay ; Ethylene Glycols ; administration & dosage ; pharmacology ; toxicity ; Guinea Pigs ; Mice ; Neutralization Tests ; Poliovirus Vaccine, Inactivated ; administration & dosage ; immunology ; toxicity ; Vero Cells

INTRODUCTIONA case is presented of a patient with severe and chronic pain in the orbital region, which was relieved by retrobulbar injection of absolute alcohol. The management of chronic pain in the orbital region has received little attention and the literature is reviewed.

CLINICAL PICTUREA 52-year-old man with adenoid cystic carcinoma of the maxillary sinus was suffering from severe pain, especially in the left orbital region. There was also pain from ocular exposure and compression caused by the tumour. Magnetic resonance imaging (MRI) revealed spread of tumour to both orbits, particularly on the left. Multiple debulking surgery and various treatment modalities offered no relief from his pain.

TREATMENTA single retrobulbar injection of 2 mL of absolute alcohol, was placed into the putative orbital apex.

OUTCOMEAs a consequence of the injection, he had complete resolution of his pain in the 6 months prior to his death.

DISCUSSIONRetrobulbar injection of alcohol offers effective pain relief in certain specific conditions characterised by chronic orbital pain when other treatments do not help.

CONCLUSIONWe have demonstrated that the retrobulbar technique still has a place in our armamentarium.

Analgesia ; Anti-Infective Agents, Local ; administration & dosage ; therapeutic use ; Carcinoma, Adenoid Cystic ; pathology ; Chronic Disease ; Ethanol ; administration & dosage ; therapeutic use ; Humans ; Injections ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Maxillary Sinus ; drug effects ; pathology ; Middle Aged ; Orbit ; drug effects ; physiopathology ; Pain ; drug therapy