Chlorhexidine
Chlorhexidine gluconate (CHG)
Hibiclens, Hibistat, Peridex (dental rinse), ChloraPrep
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Summary
Classes
Common uses
Preoperative surgical skin antisepsis0, Healthcare-worker hand antisepsis0, CLABSI prevention via daily chlorhexidine bathing in ICU patients0, Adjunctive periodontal therapy (oral rinse)0, Vascular catheter site cleansing (ChloraPrep)0
Pharmacy
Starting dose
Surgical scrub 4% CHG; preop skin prep 2% CHG/70% isopropyl alcohol (ChloraPrep); ICU bathing 2% CHG daily; oral rinse 0.12% 15 mL twice daily for 30 seconds
Preparations
2%, 4% wash; 2% CHG/70% IPA applicators (ChloraPrep); 0.12%, 0.2% oral rinse; impregnated catheter dressings
US FDA Max
Per formulation
Pharmacology
Routes
Topical, oral rinse (do not swallow)
Onset
Minutes
Duration
Persistent activity 6+ hours (residual binding to skin and oral surfaces)
Half-life
Not meaningfully described (negligible systemic absorption from intact skin or oral mucosa)[1]
Bioavailability
Topical/oral local action with minimal systemic absorption[1]
Pregnancy
Generally considered safe (minimal systemic absorption).[citation needed]
Legal status
OTC (lower-concentration washes) and Rx-only (Peridex oral rinse, ChloraPrep) in US
Purported mechanism
Chlorhexidine is a cationic bisbiguanide that binds negatively charged bacterial cell walls, disrupting membrane integrity and producing rapid bactericidal action; the residual binding to skin and oral surfaces sustains antimicrobial effect for hours after application, the basis of its dominance in surgical antisepsis.0 Hypersensitivity (including anaphylaxis) is a rising concern (FDA 2017 advisory on CHG-related anaphylaxis); also produces extrinsic dental staining and altered taste with prolonged oral rinse use. Active against most gram-positives and gram-negatives; some resistance in long-term hospital use[1].