Randomised trial of 0.2% chlorhexidine gluconate and 2.5% natamycin for fungal keratitis in Bangladesh

AIM: The management of suppurative keratitis due to filamentous fungi presents severe problems in tropical countries. The aim was to demonstrate the efficacy of chlorhexidine 0.2% drops as an inexpensive antimicrobial agent, which could be widely distributed for fungal keratitis. METHODS: Successive patients presenting to the Chittagong Eye Institute and Training Complex with corneal ulcers were admitted to the trial when fungal hyphae had been seen on microscopy. They were randomised to drop treatment with chlorhexidine gluconate 0.2% or the standard local treatment natamycin 2.5%. The diameters, depths, and other features of the ulcers were measured and photographed at regular intervals. The outcome measures were healing at 21 days and presence or absence of toxicity. If there was not a favourable response at 5 days, "treatment failure" was recorded and the treatment was changed to one or more of three options, which included econazole 1% in the latter part of the trial. RESULTS: 71 patients were recruited to the trial, of which 35 were randomised to chlorhexidine and 36 to natamycin. One allocated to natamycin grew bacteria and therefore was excluded from the analysis. None of the severe ulcers was fully healed at 21 days of treatment, but three of those allocated to chlorhexidine eventually healed in times up to 60 days. Of the nonsevere ulcers, 66.7% were healed at 21 days with chlorhexidine and 36.0% with natamycin, a relative efficacy (RE) of 1.85 (CL 1.01-3.39, p = 0.04). If those ulcers were excluded where fungi were seen in the scraping but did not grow on culture, the estimated efficacy ratio does not change but becomes less precise because of smaller numbers. Equal numbers of Aspergillus (22) and Fusarium (22) were grown. The Aspergillus were the most resistant to either primary treatment. CONCLUSIONS: Chlorhexidine may have potential as an inexpensive topical agent for fungal keratitis and warrants further assessment as a first line treatment in situations where microbiological facilities and a range of antifungal agents are not available.     

Safety and efficacy of the antiseptic chlorhexidine gluconate

Chlorhexidine gluconate, an antiseptic for the skin, has recently been investigated in a series of clinical studies on its safety and efficacy. By using standard methods, Hibiclens, Hibitane tinted tincture and 0.5 per cent aqueous chlorhexidine gluconate were shown to have an extremely low potential for the production of irritation, allergic contact sensitization, photoallergic contact sensitization and phototoxicity. In the glove fluid test for efficacy against resident flora of the hand, Hibiclens produced log10 reductions over the control of 1.9398, 2.5371 and 2.6885 for test days 1, 2 and 5, respectively. Corresponding reductions for Hibitane tinted tincture were 3.6903, 4.0984 and 4.1253 and for the aqueous formulation, 1.5003, 1.5721 and 1.8692. In a transient flora skin contamination study, Serratia marcescens was applied at an average level of 6.8363 log10 organisms per milliliter to persons' hands, after which a 15 second Hibiclens hand wash was performed. Following five of these contaminations and hand washes, there was an over-all log10 reduction in recoverable Serratia of 3.8500. Counts were further determined after ten, 15, 20 and 25 contaminations and hand washes, resulting in corresponding reductions of 4.2649, 4.6661, 4.8501 and 5.1725, respectively. Chlorhexidine gluconate offers an alternative to available antiseptics for the skin. It has been shown to be a fast acting, broad spectrum antimicrobial agent, with an extremely low potential for eliciting dermal reactions.     

Susceptibility of Chlamydia trachomatis to chlorhexidine gluconate gel

To identify topical antimicrobial preparations which may be effective in preventing the transmission of sexually transmitted diseases, we examined the activity of chlorhexidine gluconate (CHG) against Chlamydia trachomatis. Chlamydial elementary bodies were incubated with dilutions of CHG gel for various times from 0 to 120 min. An aliquot of each dilution was further diluted and was inoculated onto McCoy cell monolayers in individual wells in a 96-well microtiter plate. The cultures were incubated for 48 h, and the chlamydial inclusions were stained and counted. CHG gel diluted fourfold (0.0625% CHG) killed C. trachomatis serovar D, and CHG gel diluted eightfold (0.0313% CHG) killed serovar F immediately upon exposure. CHG gel diluted 16-fold (0.0156% CHG) killed serovar D, and CHG gel diluted 32-fold (0.0078% CHG) killed serovar F after 120 min of exposure. Alteration of the pH over the range of from 4 to 8 did not significantly affect its activity. The addition of 10% whole human blood decreased the CHG gel activity at 0 min but had no significant effect after 120 min of exposure. We conclude that CHG gel may be effective topically against C. trachomatis at concentrations that can be used and under conditions that are found in the female genital tract and that further studies of its antimicrobial efficacy and toxicity in vivo are warranted.     

Effects of tetracycline hydrochloride and chlorhexidine gluconate on Candida albicans. An in vitro study

This study examined the effects of tetracycline hydrochloride (TCN) and chlorhexidine gluconate (CHX) on the growth and viability of Candida albicans. Subcultures of Candida albicans on Sabouraud's agar, were divided into 5 treatment groups: group 1, untreated control; group 2, 0.12% CHX; group 3, 3.0 mg/ml TCN adjusted to pH 4.5; groups 4 and 5, sodium azide free Tris buffer adjusted to pH 4.5 and pH 7.4, respectively. All groups were incubated for 10 days, and sampled and subcultured daily to determine the viability of each group. Additional samples from group 2 (day 4), group 4 (day 7) and all groups at day 10 were selected for SEM and TEM examination. Visual, SEM and TEM results showed that for groups 1, 3, 4, and 5 there was a heavy and constant uniform growth of Candida albicans throughout the period of the study. However, group 2 (CHX), showed decreasing viability and attachment from day 3 to day 10, with SEM and TEM revealing decreased blastospores and profound changes in the ultrastructural morphology, indicating inhibition of normal cell growth and replication. These results show that TCN even when used at high concentrations, in vitro, will allow uninhibited growth of Candida albicans whereas CHX inhibits cell growth and replication.     

Effects of 0.05% chlorhexidine lavage on the tarsocrural joints of horses

In six horses, a 0.05% solution of chlorhexidine diacetate was used to lavage one tarsocrural joint; the contralateral control joint was lavaged with lactated Ringer's solution. Horses were evaluated daily for lameness. Synovial fluid samples were collected on days 1, 4, and 8 for determination of protein concentration, total and differential leukocyte counts, and mucin clot formation. After death on day 8, synovium and osteochondral samples were collected from the tarsocrural joints for examination of morphology and proteoglycan staining. Lavage with chlorhexidine solution caused lameness that was reduced but still evident at day 8. Synovial protein concentration was significantly increased by chlorhexidine lavage; the greatest increase occurred on day 1. Joint lavage increased synovial leukocyte counts on day 1, primarily by increasing polymorphonuclear (PMN) cell counts. Although total synovial leukocyte counts returned to normal by day 4, PMN cell counts remained elevated through day 8; PMN cell counts for chlorhexidine-lavaged joints were typically twice that of control joints. Chlorhexidine lavage caused synovial ulceration, inflammation, and abundant fibrin accumulation. Consistent differences in proteoglycan staining were not detected between control and chlorhexidine-lavaged joints. Joint lavage with 0.05% chlorhexidine diacetate, the lowest known bactericidal concentration, is not recommended for equine joints.     

Efficacy of moxidectin as a 1% injectable solution and a 0.1% oral drench against nasal bots, pulmonary and gastrointestinal nematodes in sheep

Thirty ewes, 3-10 years old, known to be naturally infected with internal parasites, were allocated to three homogeneous groups of ten ewes each based on faecal nematode egg counts. The following experimental treatments were administered on Day 0: (A) moxidectin 1% injectable solution at 0.2 mg kg-1 body weight; (B) moxidectin 0.1% oral drench solution at 0.2 mg kg-1 liveweight; (C) untreated control. Faecal samples were taken on Days -7, 0, 1, 2, 3, 7, 14, 21, 28 and 35 to obtain counts of nematode eggs. One-half of the ewes in each treatment group were slaughtered 14 days after dosing, while the remainder were slaughtered 35 days after treatment to count the numbers of nasal bots, pulmonary nematodes and gastrointestinal nematodes. Moxidectin 1% injectable solution and moxidectin 0.1% oral drench solution were highly effective against gastrointestinal nematodes and against a variable infection of Dictyocaulus filiaria. Moxidectin 1% injectable solution was effective against first stage larvae of Oestrus ovis, whereas moxidectin 0.1% oral drench was ineffective.     

Comparison of the efficacy of 40% chlorhexidine varnish and 1% chlorhexidine-fluoride gel in decreasing the level of salivary mutans streptococci

The aim of the study was to compare the efficacy of a 40% chlorhexidine (CHX) varnish (EC40, Certichem, Nijmegen, The Netherlands) with a 1% CHX-0.2% NaF gel in decreasing the level of salivary mutans streptococci (MS). The subjects were screened for a high level of MS using a Dentocult-SM strip method (Orion Diagnostica, Finland). In varnish groups with fluoride (VCHXF, n = 20) and without fluoride (VCHX, n = 19), the CHX varnish was applied on dry teeth using an ampoule and an anesthetic syringe with blunt needle, and removed after 15 min. In group VCHXF an additional 2.26% fluoride varnish (Duraphat, Woelm Pharma GmbH, Eschwege, Germany) was applied. The CHX-NaF gel treatment included the application of the gel with rubber cups and dental tape for 5 min on three occasions during a week in group GCHXF (n = 21). The level of MS (MSB agar) was significantly lower after 4 weeks than at baseline in VCHX (p < 0.001) and VCHXF (p < 0.05), but not after 12 weeks. In GCHXF a significant decrease (p = 0.001) was observed after 4 weeks only with the strip method. In VCHX and VCHXF the strip values for MS were still reduced after 12 weeks. In VCHX and GCHXF a small, although statistically significant, increase was observed in the total number of microorganisms after 4 and 12 weeks. Opinions on taste sensations associated with the treatments were generally negative, but least negative in the VCHXF group; fewer side effects were also reported in the VCHXF group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metabolic evaluation of a 75% lipid/25% glucose high nitrogen solution for intravenous nutrition

OBJECTIVE: To compare the metabolic response to a 75% lipid/25% glucose regimen of intravenous feeding with that of a regimen of isocaloric isonitrogenous glucose alone. DESIGN: Randomised crossover study. SETTING: University department of surgery. SUBJECTS: 14 Patients (of 18 consecutive) who did not develop infections after major upper gastrointestinal operations. INTERVENTIONS: Patients received five days of each of two regimens, both of which provided 0.38 g nitrogen and 0.155 MJ (37 kcal)/kg/day. MAIN OUTCOME MEASURES: Nitrogen balance, prealbumin and transferrin concentrations, and basal efflux of amino acids from the lower limb before and after a five day course of each regimen. RESULTS: Mean (SD) nitrogen balance increased from -11.4 (2.6) g/day to 1.7 (4.1) and 1.6 (5.5) g/day after lipid/glucose and glucose alone, respectively (p < 0.0001). Basal prealbumin and transferrin concentrations increased after both regimens, but significantly so only after lipid/glucose (p < 0.01 and < 0.02, respectively). Mean (SD) net basal efflux of total amino acids from the lower limb was significantly reduced after both regimens, (p < 0.0001 in each case). Net basal alanine efflux was significantly reduced only by glucose alone, and basal glutamine efflux only by lipid/glucose (p < 0.05 in each case). Plasma free fatty acids were increased only by glucose alone (p < 0.001), and glucose alone augmented tissue uptake of glucose significantly more than lipid/glucose (p < 0.01 and < 0.05, respectively). CONCLUSIONS: The solution high in lipids and nitrogen was well tolerated. There was no difference in improvements in nitrogen balance or amino acid flux across the lower limb, but lipid/glucose was associated with higher increases in visceral protein concentrations.     

The effect of baking soda/hydrogen peroxide dentifrice (Mentadent) and a 0.12 percent chlorhexidine gluconate mouthrinse (Peridex) in reducing gingival bleeding

The purpose of this study was to determine the effectiveness of a baking soda/hydrogen peroxide dentifrice, Mentadent, and a 0.12 percent chlorhexidine gluconate mouthrinse, Peridex, in reducing gingival bleeding. Forty subjects were divided into three groups; the baking soda group, the chlorhexidine group and the control group. All groups received oral hygiene instruction and brushed and flossed three times per day. Bleeding point scores were evaluated at baseline and at five weeks. The baking soda/hydrogen peroxide group used the supplied dentifrice as their sole toothpaste. The 0.12 percent chlorhexidine group used the mouthrinse twice per day. The control group performed oral hygiene as instructed. At five weeks, the 0.12 percent chlorhexidine mouthrinse significantly reduced gingival bleeding. The dentifrice and control groups revealed no statistically significant reductions. The results indicate that the 0.12 percent chlorhexidine mouthrinse is useful in improving oral health, whereas the baking soda/hydrogen peroxide dentifrice offered no advantages to conventional oral hygiene.     

A comparative in-vitro study of the bactericidal efficacy of sodium hypochlorite and chlorhexidine gluconate plus cetrimide on root canal anaerobic bacterial flora

INTRODUCTION: The permanence of necrotic tissues and/or bacteria may be responsible for persistent root canal infection. Root canal irrigation plays an important role in the success of endodontic treatment given that, on the one hand, it encourages the progressive elimination of the smear layer and, on the other, it neutralises microbic flora within the canal. The aim of this study was to test root canal irrigants from a microbiological point of view: sodium hypochlorite 5% (Niclor Ogna, Milan) and a new generation irrigant based on chlorhexidine gluconate and cetrimide (Cetrexidine VEBAS S. Giuliano Milanese-MI). METHODS: The experiments were performed on a series of obligatory anaerobic bacteria which are most frequently found in the endodontium, all belonging to the international collection "American Type Culture Collection" (ATCC) and supplied by Dasit SpA, Cornaredo (MI). The following bacterial strains were used in the experiment: Actinimyces odontolyticus ATCC 17929, Fusobacterium nucleatum ATCC 25586, Prevotella melanginogenica ATCC 25845, Porphyromonas gingivalis ATCC 33277. The working concentration (CFU/ml) was defined as 0.5 McFarland which corresponds to a concentration of microorganisms equivalent to approx. 1.5 x 10(3) bacteria. Each irrigant was kept in contact with the bacterial species used for this experiment for 10', 20', 30'. RESULTS: The results obtained confirm the bactericidal efficacy of both irrigants used, even after a short contact time. CONCLUSIONS: This does not mean that all irrigants are the same and/or promise the same results. This was a microbiological study, but in practice it is important to bear in mind other variables, such as contact time. Moreover, in order to increase the probability of endodontic treatment, root canal irrigants are also required to satisfy other criteria: biocompatibility, scarce toxicity, high proteolytic power.     

In vitro evaluation of the effect of profound haemodilution with hydroxyethyl starch 6%, modified fluid gelatin 4% and dextran 40 10% on coagulation profile measured by thromboelastography

Synthetic colloids have been implicated as a cause of coagulopathy when administered in large quantities. The effect of profound haemodilution (50%) on coagulation profile was measured in vitro by thromboelastography. Blood samples were taken from 11 ASA grade 1 patients prior to induction of anaesthesia for elective surgery. Each sample was simultaneously tested in four different preparations: undiluted blood (control sample); blood diluted with hydroxyethyl starch 6%; blood diluted with modified fluid gelatin 4%; blood diluted with dextran 40 10%. There was a significant decrease in reaction time in the preparations treated with hydroxyethyl starch 6% and modified fluid gelatin 4%, reflecting activation of initial fibrin formation. A significant increase in clot formation time was noted in the hydroxyethyl starch 6%-treated preparations. There was also a significant decrease in clot formation rate and maximum amplitude in the hydroxyethyl starch 6% group. Clot formation time, clot formation rate and maximum amplitude did not change in the modified fluid gelatin 4% group. Profound haemodilution with dextran 40 10% exerted extreme effects on the measured variables, very often resulting in a straight line on the thromboelastography profile.     

25%的硫酸镁佐治小儿喘息性支气管炎及支气管肺炎疗效观察

目的:探讨25%的硫酸镁辅佐治疗小儿喘息性支气管肺炎的临床效果,为指导临床用药提供依据.方法:将确诊为喘息性支气管炎或支气管肺炎的98例患儿随机分为2组,观察组在常规抗炎、抗病毒、平喘等治疗的基础上应用25%的硫酸镁进行辅佐治疗;对照组采用常规抗炎、抗病毒等治疗.结果:观察组的治疗效果明显好于对照组,两组之间的疗效差异显著,据有统计学意义(p<0.05).结论:25%的硫酸镁小儿喘息性支气管肺炎的辅佐治疗中效果明显,适合在临床实践中推广应用.     

6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo. (I). Effect on plaque formation and gingivitis

A double-blind, randomised, 6-month clinical trial with parallel group design in 149 patients with gingivitis was conducted to study the efficacy and safety of delmopinol hydrochloride 2 mg/ml (0.2% w/v, Decapinol Mouthwash) used for partly supervised mouthrinsing in comparison with chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental, ICI Pharmaceuticals, UK) and placebo as an addition to normal oral hygiene. Assessments of efficacy were performed using the plaque index and bleeding on probing (BOP). Delmopinol showed 22% lower plaque index scores than placebo after 3 months (p<0.01) and 13% lower scores after 6 months. The corresponding figures for chlorhexidine were 38% (p<0.001) and 38% (p<0.001) after 3 and 6 months, respectively. Bleeding on probing was reduced for delmopinol in comparison with placebo by 11% after 3 months and by 18% (p<0.05) after 6 months. For chlorhexidine the corresponding figures were 18% (p<0.01) and 22% (p<0.01) after 3 and 6 months, respectively. While chlorhexidine showed greater plaque reduction than delmopinol (p<0.01 at 6 months), no statistically significant difference was reached between these two solutions regarding BOP. Both active solutions showed an increased amount of dental calculus in comparison with placebo. A transient anaesthetic sensation in the oral mucosa and taste affection were commonly reported adverse events in both the delmopinol and the chlorhexidine groups. The number of patients withdrawn from treatment due to adverse events or lack of cooperation was 7 in the chlorhexidine group, 4 in the placebo group and 1 in the delmopinol group. The results showed that rinsing with either 0.2% delmopinol hydrochloride or 0.2% chlorhexidine digluconate twice daily for 60 secs for 6 months results in less plaque formation and gingivitis than rinsing with placebo. Mouthrinsing with the 0.2% delmopinol hydrochloride solution was well accepted in this study.     

Efficacy of lodoxamide 0.1% versus N-acetyl aspartyl glutamic acid 6% ophthalmic solutions in patients with vernal keratoconjunctivitis

The purpose of this study was to investigate environmental lead exposure in the general Taiwanese population. A total of 8828 Taiwanese adults selected by a multistage sampling method were investigated. Characteristics of the participants were ascertained by questionnaire and 10 ml venous blood was drawn by public health nurses. The blood specimens were distributed to six laboratories for blood lead level (BLL) measurement. A quality control program was applied during the analysis of the BLLs in order to improve precision and accuracy. The arithmetic mean BLL of the 8828 Taiwanese adults was 7.70 +/- 5.23 micrograms/dl, with a maximal level of 69.1 micrograms/dl. The median was 6.5 micrograms/dl and the 90th percentile was 14.0 micrograms/dl. After logarithmic transformation, the geometric mean was 1.84 +/- 0.67 microgram/dl. This study also found that elevated BLLs were associated with certain personal characteristics, i.e., gender, ethnic group, and education level; life-style factors, such as smoking, alcohol consumption, Chinese herbal drug consumption, milk consumption, and sources of drinking water; residential location, i.e., level of urbanization; and occupational history of lead exposure. However, age, floor level of residence, distance from house to road, and betel nut consumption were not associated with elevated BLLs. These results showed that BLLs in the Taiwanese population were not higher than those in developed and developing countries. Most of the influencing factors were also found in other studies; however, local factors such as ethnic group, Chinese herbal drug consumption, and sources of drinking water are important considerations in Taiwan when examining ways to prevent overexposure to lead in the general population.