Evidence of incompatibility for topical anionic agents used in conjunction with chlorhexidine gluconate: A systematic review

Gary Tran; Thy N Huynh; Finola M Bruins; Najeah Ahmad; William A Budris; Alba Posligua; Josh A Hammel; Beatrice Nardone; Dennis P West

doi:10.18282/jsd.v6.i1.21

Gary Tran Northwestern University
Thy N Huynh Northwestern University
Finola M Bruins Northwestern University
Najeah Ahmad Northwestern University
William A Budris Northwestern University
Alba Posligua Northwestern University
Josh A Hammel Northwestern University
Beatrice Nardone Northwestern University
Dennis P West Northwestern University

DOI: https://doi.org/10.18282/jsd.v6.i1.21

Keywords: chlorhexidine, incompatibility, inactivation, skin, reduced antibacterial activity, precipitation, systematic review

Abstract

Chlorhexidine gluconate (CHG) is a widely used antiseptic agent for skin and wound disinfection. The cationic properties of CHG may allow its inactivation and precipitation by anionic agents in commonly used topical agents. We conducted a systematic review by searching through PubMed, Cochrane Library, and Web of Science databases and selected original research articles reporting on CHG incompatibility, defined as inactivation or precipitation. The search yielded 22 publications that demonstrated CHG incompatibility via: 1) reduced antibacterial activity (carbomer, acrylates/C10-C30 alkyl acrylate crosspolymer, dentin, bovine serum albumin, copolymer M239144, sodium lauryl sulfate, heat-killed microbes, triethanolamine, and bark cork); and 2) visible precipitate formation (sodium hypochlorite, EDTA, saline, ethanol, andnystatin). Only three publications reported on CHG incompatibility in dermatology, specifically for carbomer, triethanolamine, and acrylates/C10-C30 alkyl acrylate crosspolymer. Although limited evidence linking CHG incompatibility and anionic agents exists, clinicians should carefully consider the nature of topical agents used if CHG is concurrently applied. Increased awareness of CHG incompatibility may result in better antibacterial activity thus ensuring optimal patient management.

Author Biographies

Gary Tran, Northwestern University

Department of Dermatology
Pre-doctoral research fellow

Thy N Huynh, Northwestern University

Department of Dermatology
Post-doctoral research fellow

Finola M Bruins, Northwestern University

Department of Dermatology
Pre-doctoral research fellow

Najeah Ahmad, Northwestern University

Department of Pharmacy
PharmD

William A Budris, Northwestern University

Department of Pharmacy
Registered pharmacist

Alba Posligua, Northwestern University

Department of Dermatology
Post-doctoral research fellow

Josh A Hammel, Northwestern University

Department of Dermatology
Post-doctoral research fellow

Beatrice Nardone, Northwestern University

Department of Dermatology
Research assistant professor

Dennis P West, Northwestern University

Vincent W. Foglia Family Research Professor of Dermatology
Professor of Dermatology and Pediatrics
Director, Dermatopharmacology Program
Director, Dermatology Translational Core

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