Antiseptics

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 chemical agents that slow or stop the growth of
micro-organisms (germs) on external surfaces of the body and help prevent
infections.

Antiseptics should be distinguished from antibiotics that destroy micro-organisms

inside the body, and from disinfectants, which destroy micro-organisms found on
inanimate (non-living) objects. However, antiseptics are often referred to as skin
disinfectants.

Types of Antiseptics

Antiseptics can be classified according to their chemical structure. Commonly used

antiseptic groups include alcohols, quaternary ammonium compounds, chlorhexidine
and other diguanides, antibacterial dyes, chlorine and hypochlorites,
inorganic iodine compounds, metals, peroxides and permanganates, halogenated
phenol derivatives and quinolone derivatives

The following table lists some of the agents within these groups.

Group Agent Uses

Alcohols Ethyl alcohol 70%  Skin disinfectant

Isopropyl alcohol 70%

Quaternary Benzalkonium chloride  Skin disinfectant 

ammonium Cetrimide  Irrigations 
compounds Methylbenzethonium chloride  Eye drop
Benzethonium chloride  preservative
Cetalkonium chloride 
Cetylpyridinium chloride 
Dofanium chloride 
Domiphen bromide

Chlorhexidine Chlorhexidine gluconate  Pre-op skin

and other Chlorhexidine acetate disinfectant 
diguanides Treat wounds 
 Bladder irrigations

Antibacterial Proflavine hemisulphate  Skin disinfectant 

dyes Triphenylmethane  Treat wounds and
Brilliant green  burns
Crystal violet 
Gentian violet

Peroxides and Hydrogen peroxide solution  Wound cleanser 

permanganates Potassium permanganate solution  Gargles
Benzoyl peroxide and mouthwashes 
Irrigations 
Skin disinfectant

Halogenated Chlorocresol  Skin disinfectant 

phenol Chloroxylenol  Medicated soaps
derivatives Chlorophene  and solutions
Hexachlorophane/hexachlorphene
(no longer available)
Triclosan

Quinolone Hydroxyquinoline sulphate  Treat wounds 

derivatives Potassium hydroxyquinoline Throat lozenges 
sulphate  Skin disinfectant
Chlorquinaldol 
Dequalinium chloride 
Di-iodohydroxyquinoline

Miscellaneous Burow's solution (aqueous solution

of aluminium acetate) 
Bleach baths

Purpose and uses

The purpose for which it is used is determined by its concentration. For
example hydrogen peroxide 6% solution is used for cleansing wounds, while stronger
solutions (>30%) are used in industry as a bleach and oxidising agent.

Antiseptics are mainly used to reduce levels of microorganisms on the skin

and mucous membranes. The skin and mucous membranes of the mouth, and nose,
are home to a large number of what are usually harmless micro-organisms. However,
when the skin or mucous membranes are damaged or breached in surgery, antiseptics
can be used to disinfect the area and reduce the chances of infection. It is also
important that people whom are treating patients with wounds or burns adequately
wash their hands with antiseptic solutions to minimize the risk of cross infection.

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 when using Antiseptics

Strong antiseptics should be diluted before they are applied to the skin, as
concentrated products including chlorhexidine may cause chemical burns or
severe irritant contact dermatitis. Prolonged contact with diluted antiseptics can also
cause erosive contact dermatitis, as described with chlorhexidine-impregnated
dressings.

Antiseptics bought from the pharmacy should not be used for more than one week. If
the affected area has not healed or improved in that time you should stop using the
antiseptic and see your doctor. Large wounds, deep cuts, burns larger than a small red
spot, scrapes imbedded with particles that won’t wash away, animal bites and eye
injuries should be treated by your doctor. Do not use antiseptics to treat sunburn or
existing skin infections. Remember that antiseptics only reduce microorganisms on
the surface of the tissue and that antibiotics will be needed to treat infection within
the tissues.

People with allergies of any kind should check with a doctor or pharmacist before
using an over-the-counter antiseptic product. Some antiseptics can irritate the skin
and cause allergic contact dermatitis. Chlorhexidine has been reported to rarely
cause anaphylaxis

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.

References

Book: Pharmaceutical Handbook. Ed Wade A. Nineteenth edition. The

Pharmaceutical Press.

Weitz NA, Lauren CT, Weiser JA, LeBoeuf NR, Grossman ME, Biagas K, Garzon
MC, Morel KD. JAMA Dermatol. 2013 Feb:149(2):195-9. PubMed

United States Department of Energy. "Antiseptics and Disinfectants." Ask A

Scientist: Molecular Biology Archive. December 04, 2002 [cited June 29, 2003].

Periodicals

McDonnell, Gerald and A. Denver Russell. "Antiseptics and Disinfectants: Activity,

Action, and Resistance." Clinical Microbiology Reviews Vol. 12, No. 1 (January
1999): 147–179.

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).