Class: Anti-infectives, Miscellaneous
Chemical Name: N,N″-Bis(4-chlorophenyl)-3,12-diimino- 2,4,11,13-tetraazatetradecanediimidamide di-d-gluconate
Molecular Formula: C22H30Cl2N10•2C6H12O7
CAS Number: 18472-51-0
Brands: Paroex, Peridex, PerioChip, PerioGard
Medically reviewed by Drugs.com. Last updated on Apr 16, 2018.
Uses for Chlorhexidine Gluconate
Used subgingivally (extended-release insert) for treatment of adult periodontitis as an adjunct to scaling and root planing to reduce periodontal pocket depth;3 used as part of a periodontal maintenance program that includes good oral hygiene.3
Prevention of Dental Caries
Has been used as a topical oral solution for prevention of dental plaque and dental caries† when conventional oral hygiene measures are difficult or impossible, such as in patients with fractured jaws, periodontal surgery, or orthodontic treatments and in patients with seizure disorders, rheumatoid arthritis, mental retardation, and cerebral palsy.8 33 34 44
Mucositis and Other Oral Complications in Individuals with Altered Immunocompetence
Has been used as a topical oral solution to decrease incidence and severity of mucositis† and other oral complications† in patients with altered immunocompetence, including those undergoing bone marrow transplantation,10 11 14 20 21 radiation therapy,15 21 38 or chemotherapy.12 13 15 19 20 21 38
Has been used as a topical oral solution as adjunct to surgical debridement, plaque removal, and systemic anti-infectives in treatment of linear gingival erythema†, necrotizing ulcerative gingivitis†, and necrotizing ulcerative periodontitis† in immunocompromised individuals, including patients with HIV infection.88 89
Such use has been beneficial for prevention or treatment of oral complications in some immunocompromised individuals,10 12 13 14 15 20 21 62 but inconsistent results reported in some studies.11 19 20 21
Oropharyngeal Decontamination in Critically Ill Patients
Has been used as a topical oral solution for oral hygiene and oropharyngeal decontamination in an attempt to decrease the incidence of nosocomial respiratory tract infections in critically ill patients†, including immunocompromised patients and those undergoing mechanical ventilation or heart surgery.19 21 39 85 86
Chlorhexidine Gluconate Dosage and Administration
Oral, Topical Use Only
Immediately prior to initiation of treatment, provide professional dental prophylaxis.1 2 90 91 Reevaluate patient with thorough dental prophylaxis throughout treatment at intervals not exceeding 6 months.1 2 90 91
Instruct patients to brush their teeth immediately prior to each use of the topical oral solution.1 2 90 91 Then, place appropriate volume of the oral solution into the mouth, swish for 30 seconds, and expectorate the solution.1 2 90 91
Administered subgingivally as extended-release inserts into periodontal pockets by a dental health-care provider.3
Place a single insert containing 2.5 mg of chlorhexidine gluconate into each periodontal pocket that has a probing depth ≥5 mm.3
Isolate periodontal pocket and dry surrounding area prior to insertion.3 Grasp flat end of insert with forceps and place (curved end first) into periodontal pocket to its maximum depth.3 If necessary, further maneuver insert into position using tips of forceps or a flat instrument.3
Advise patients to avoid dental floss at insertion sites for 10 days after placement.3
If insert dislodges ≤48 hours after placement, place a new insert.3 If insert dislodges >48 hours but <7 days after placement, do not replace insert; reevaluate at 3 months and place new insert if pocket depth has not been reduced to <5 mm.3 If insert dislodges ≥7 days after placement, no action required since this is considered a full course of treatment.3
Inserts will biodegrade within periodontal pockets and do not need to be manually removed.3
Consult manufacturer’s literature for additional information on subgingival administration of chlorhexidine inserts.3
Oral, Topical Use Only
Dosage varies depending on size, shape, and number of periodontal pockets treated.3
Place new insert every 3 months into pockets that continue to have a probing depth of ≥5 mm.3
Consider other treatment options (e.g., combination therapy, surgical intervention) if periodontal pockets with a probing depth of ≥5 mm do not respond within 9–12 months.79
Maximum of 8 inserts during a single visit.3
Cautions for Chlorhexidine Gluconate
Serious allergic reactions, including fatal anaphylaxis, reported rarely with topical chlorhexidine preparations used on the skin (e.g., solutions, washes, sponges, swabs), including OTC topical preparations.4 45 48 63 64 66 92
Hypersensitivity reactions can occur within minutes following topical exposure.92 Symptoms may include wheezing or difficulty breathing, facial swelling, urticaria that can quickly progress to more serious symptoms, severe rash, or life-threatening shock.92
Prior to prescribing or recommending any preparation that contains chlorhexidine, ask patients whether they have ever had an allergic reaction to antiseptics or any preparation containing chlorhexidine.92
If allergic reaction occurs or is suspected, discontinue the drug and carefully monitor the reaction and provide immediate respiratory and/or cardiovascular support as needed.92
Precautions Related to Topical Oral Solution
Possible staining of teeth and other oral surfaces, such as tooth surfaces, restorations, and dorsum of the tongue.1 2 4 5 8 10 18 90 91 Stains usually can be removed by conventional professional prophylactic techniques, although additional time may be required to complete the prophylaxis.1 2 90 91
Effect on periodontitis not determined.1 2 90 91 If used as a mouthwash or oral rinse in patients with coexisting gingivitis and periodontitis, presence or absence of gingival inflammation following treatment should not be used as a major indicator of underlying periodontitis.1 2 90 91
Precautions Related to Subgingival Inserts
Use in acutely abscessed periodontal pockets not studied and not recommended.3 Management of periodontal disease should include consideration of potentially contributing medical disorders, such as cancer, diabetes, and compromised immune function.3
Avoid dental floss at insertion site for 10 days after placement; flossing might dislodge insert.3
Some mild to moderate sensitivity is normal during first week after placement of a subgingival insert; however, dentist should be promptly notified if pain, swelling, or other problems occur.3
Subgingival insert: Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.3 No overall differences in safety or efficacy between geriatric and younger adults.3
Common Adverse Effects
Chlorhexidine Gluconate Pharmacokinetics
Topical oral solution: Systemic absorption does not appear to occur following use as a mouthwash or oral rinse.78
Following use of a 0.12% topical oral solution of chlorhexidine gluconate as a mouthwash or oral rinse, approximately 30% of drug is retained in oral cavity.1 2 5 8 34 90 91 The drug is bound to phosphate groups principally on coatings of mucous membrane surfaces8 and gradually released into oral fluids1 2 5 8 34 90 91 for up to 24 hours.8
Following subgingival administration of biodegradable extended-release insert containing 2.5 mg of chlorhexidine gluconate, the drug is slowly released into periodontal pocket.3 50 In vitro study indicates approximately 40% of the drug is released during first 24 hours and remainder is released in almost linear manner over 7–10 days.3
Following oral administration† of a 300-mg dose of chlorhexidine gluconate, peak plasma concentrations of 0.206 mcg/mL were attained 30 minutes after the dose; however, the drug was undetectable in plasma 12 hours after the dose.1 2 77 90
Oral, Topical Use Only
20–25° C (may be exposed to 15–30°).3
Actions and Spectrum
Cationic compound; antibacterial activity results from attraction between positively charged chlorhexidine and negatively charged bacterial cell surfaces.3 5 8 Becomes adsorbed onto cell surfaces of susceptible organisms and disrupts cell membrane integrity resulting in increased permeability.8 33 34
Topical oral solution: When used as a mouthwash or oral rinse, chlorhexidine binds to negatively charged surfaces within the oral cavity, including hydroxyapatite of tooth enamel, pellicle on tooth surface, oral mucosa, salivary glycoproteins, and bacteria and extracellular polysaccharides of bacterial origin.5 8 33 34 Can provide a persistent bacteriostatic effect at tooth surface.8 33 34 May provide antiplaque effects because of bacteriostatic or bactericidal effects on salivary bacteria and bacteria adhering to tooth surfaces.34
Subgingival insert: After placement into periodontal pockets, numbers of some organisms associated with periodontal disease, including Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, and Campylobacter rectus, were reduced.3 Clinical importance unknown.3
Active against some aerobic and anaerobic gram-positive and gram-negative bacteria.8 22 33 54 55 56 57 60 Also has some activity against Chlamydia trachomatis,74 certain fungi,8 33 42 49 59 and certain viruses,33 53 but is inactive against mycobacteria.71
Advice to Patients
Topical oral solution: Advise patients to use the solution on a regular basis as directed by their dental health-care provider and to brush their teeth immediately prior to each use.1 2 90 91 Importance of expectorating the solution after 30 seconds and importance of not rinsing with water or other mouthwashes and not brushing their teeth or eating immediately after using the solution.1 2 90 91
Topical oral solution: Advise patients that the solution may cause some tooth discoloration or increase in tartar (calculus) formation.1 2 90 91 Importance of contacting dental health-care provider for removal of any stain or tartar at least every 6 months or more frequently if needed.1 2 90 91
Topical oral solution: Advise patients that the solution may taste bitter and can affect how foods and beverages taste; this usually becomes less noticeable with continued use.2 90 91 Using the solution after meals may avoid taste interference.2 90 91
Subgingival insert: Advise patients to avoid dental floss at the insertion site for 10 days following insert placement.3 Importance of notifying dental health-care professional if an insert is dislodged or if pain, swelling, or other problems occur.3
Subgingival insert: Advise patients that some mild to moderate sensitivity is normal during first week after insert placement; importance of promptly notifying dental health-care provider if pain, swelling, or other problems occur.3
Advise patients receiving topical oral solution or subgingival insert to immediately contact a clinician and stop using the product if they experience any symptoms of an allergic reaction (e.g., rash, itching, hives, generalized or facial swelling, wheezing or breathing difficulties, lightheadedness, rapid heart rate, shock, upset stomach or diarrhea).2 3 90 91 92
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Oral (Topical Use Only)
Chlorhexidine Gluconate Oral Rinse
PerioGard Alcohol Free
AHFS DI Essentials™. © Copyright 2019, Selected Revisions April 16, 2018. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
1. Colgate Oral Pharmaceuticals. PerioGard (chlorhexidine gluconate) oral rinse USP 0.12% prescribing information. New York, NY; 2015 Jul.
2. 3M ESPE Dental Products. Peridex (chlorhexidine gluconate) 0.12% oral rinse prescribing information. St. Paul, MN; 2017 Oct.
3. Dexcel Pharma Technologies. PerioChip (chlorhexidine gluconate) 2.5 mg extended-release insert prescribing information. Yokneam, Israel; 2012 Nov.
4. Martindale: the complete drug reference. 32nd ed. Parfitt K, ed. London: Pharmaceutical Press, 1999:1229-31.
5. Robinson CP. Chlorhexidine gluconate oral rinse (Peridex oral rinse)—a review. Drugs of Today. 1988; 24:221-8.
6. Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R eds. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000:690-702.
7. Tattawasart U, Maillard JY, Furr JR et al. Development of resistance to chlorhexidine diacetate and cetylpyridinium chloride in Pseudomonas stutzeri and changes in antibiotic susceptibility. J Hosp Infect. 1999; 42:219-29. http://www.ncbi.nlm.nih.gov/pubmed/10439995?dopt=AbstractPlus
8. Farndal O, Turnbull RS. A review of the literature on use of chlorhexidine in dentistry. J Amer Dental Assoc. 1986; 112:863-9.
9. Killoy WJ. Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis. J Amer Dent Assoc. 1999; 130:567-70.
10. Ferretti GA, Ash RC, Brown AT et al. Chlorhexidine for prophylaxis against oral infections and associated complications in patients receiving bone marrow transplants. J Amer Dent Assoc. 1987; 114:461-7.
11. Epstein JB, Vickars L, Spinelli J et al. Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation. Oral Surg Oral Med Oral Pathol. 1992; 73:682-9. http://www.ncbi.nlm.nih.gov/pubmed/1437036?dopt=AbstractPlus
12. Rutkauskas JS, Davis JW. Effects of chlorhexidine during immunosuppressive chemotherapy. A preliminary report. Oral Surg Oral Med Oral Pathol. 1993; 76:441-8. http://www.ncbi.nlm.nih.gov/pubmed/8233423?dopt=AbstractPlus
13. McGaw WT, Belch A. Oral complications of acute leukemia: prophylactic impact of a chlorhexidine mouth rinse regimen. Oral Surg Oral Med Oral Pathol. 1985; 60:275-80. http://www.ncbi.nlm.nih.gov/pubmed/3862040?dopt=AbstractPlus
14. Ferretti GA, Ash RC, Brown AT et al. Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant. 1988; 3:483-93. http://www.ncbi.nlm.nih.gov/pubmed/3056555?dopt=AbstractPlus
15. Ferretti GA, Raybould TP, Brown AT et al. Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double- blind trial. Oral Surg Oral Med Oral Pathol. 1990; 69:331-8. http://www.ncbi.nlm.nih.gov/pubmed/2179802?dopt=AbstractPlus
16. Russell AD, Day MJ. Antibacterial activity of chlorhexidine. J Hosp Infect. 1993; 25:229-38. http://www.ncbi.nlm.nih.gov/pubmed/7907620?dopt=AbstractPlus
17. Bollen CML, Quirynen M. Microbiological response to mechanical treatment in combination with adjunctive therapy. A review of the literature. J Periodontol. 1996; 67:1143-58. http://www.ncbi.nlm.nih.gov/pubmed/8959563?dopt=AbstractPlus
18. Greenstein G, Polson A. The role of local drug delivery in the management of periodontal diseases: a comprehensive review. J Periodontol. 1998; 69:507-20. http://www.ncbi.nlm.nih.gov/pubmed/9623893?dopt=AbstractPlus
19. Bunetel L, Bonnaure-Mallet M. Oral pathoses caused by Candida albicans during chemotherapy. Oral Surg Oral Med Oral Pathol. 1996; 82:161-5.
20. Epstein JB, Schubert MM. Oral mucositis in myelosuppressive cancer therapy. Oral Surg Oral Med Oral Pathol. 1999; 88:273-6.
21. Committee on Research, Science, and Therapy et al. Position Paper. Periodontal considerations in the management of the cancer patient. J Periodontol. 1997; 68:791-801. http://www.ncbi.nlm.nih.gov/pubmed/9287071?dopt=AbstractPlus
22. Barry AL, Fuchs PC, Brown SD. Lack of effect on antibiotic resistance on susceptibility of microorganisms to chlorhexidine gluconate or povidone iodine. Eur J Clin Microbiol Infect Dis. 1999; 18:920-1. http://www.ncbi.nlm.nih.gov/pubmed/10691210?dopt=AbstractPlus
23. Jeffcoat MK, Bray KS, Ciancio SG et al. Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontol. 1998; 69:989-97. http://www.ncbi.nlm.nih.gov/pubmed/9776027?dopt=AbstractPlus
24. Aursnes J. Cochlear damage from chlorhexidine in guinea pigs. Acta Otolaryngol. 1981; 92:259-71. http://www.ncbi.nlm.nih.gov/pubmed/7324895?dopt=AbstractPlus
25. Tabor E, Bostwick DC, Evans CC et al. Corneal damage due to eye contact with chlorhexidine gluconate. JAMA. 1989; 261:557-8. http://www.ncbi.nlm.nih.gov/pubmed/2909794?dopt=AbstractPlus
26. MacRae SM, Brown B, Edelhauser HF. The corneal toxicity of presurgical skin antiseptics. Am J Ophthalmol. 1984; 97:221-32. http://www.ncbi.nlm.nih.gov/pubmed/6696033?dopt=AbstractPlus
27. Jeffcoat MK, Palcanis KG, Weatherford TW et al. Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings. J Periodontol. 2000; 71:256-62. http://www.ncbi.nlm.nih.gov/pubmed/10711616?dopt=AbstractPlus
28. Ellenhorn MJ, Schonwald S, Ordog G et al. eds. Ellenhorn’s medical toxicology. 2nd ed. Baltimore: Williams & Wilkins; 1997:1208-10.
29. Case DE. Safety of Hibtain. I. Laboratory experiments. J Clin Periodontol. 1977; 4:66-72. http://www.ncbi.nlm.nih.gov/pubmed/275278?dopt=AbstractPlus
30. Massano G, Ciocatto E, Rosabianca C et al. Striking aminotransferase rise after chlorhexidine self-poisoning. Lancet. 1982; 1:289. http://www.ncbi.nlm.nih.gov/pubmed/6120309?dopt=AbstractPlus
31. Quinn MW, Bini RM. Bradycardia associated with chlorhexidine spray. Arch Dis Child. 1989; 64:892-3. http://www.ncbi.nlm.nih.gov/pubmed/2774629?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1792556&blobtype=pdf
32. Anderson MH, Bales DJ, Omnell KA. Modern-management of dental caries: the cutting edge is not the dental bur. J Amer Dent Assoc. 1993; 124:37-44.
33. Denton DW. Chlorhexidine. In: Block SS, ed. Disinfection, sterilization, and preservation. 4th edition. Philadelphia: Lea & Febiger; 1991:274-89.
34. Jones CG. Chlorhexidine: is it still the gold standard? Periodontology 2000. 1997; 15:55-62.
35. Netuschil L, Weiger R, Preisler R et al. Plaque bacteria counts and vitality during chlorhexidine, meridol, and listerine mouthrinses. Eur J Oral Sci. 1995; 103:355-61. http://www.ncbi.nlm.nih.gov/pubmed/8747670?dopt=AbstractPlus
36. Laufman H. Current use of skin and wound cleansers and antiseptics. Am J Surg. 1989; 157: 3:359-65. http://www.ncbi.nlm.nih.gov/pubmed/2645807?dopt=AbstractPlus
37. Fourrier F, Cau-Pottier, Boutigay et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Inten Care Med. 2000; 26:1239-47.
38. Dodd MJ, Dibble SL, Miaskowski C et al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy- induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90:39-47. http://www.ncbi.nlm.nih.gov/pubmed/10884634?dopt=AbstractPlus
39. DeRiso AJ, Ladowski JS, Dillon TA et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996; 109:1556-61. http://www.ncbi.nlm.nih.gov/pubmed/8769511?dopt=AbstractPlus
40. Sokolne WA, Heasman PA, Stabholz A et al. Sustained local delivery of chlorhexidine in the treatment of periodontitis: a multi-center study. J Periodontol. 1997; 68:32-8. http://www.ncbi.nlm.nih.gov/pubmed/9029449?dopt=AbstractPlus
41. Bollmer BW, Sturzenberger OP, Vick V et al. Reduction of calculus and Peridex stain with Tartar-control Crest. J Clin Dent. 1995; 6:185-7. http://www.ncbi.nlm.nih.gov/pubmed/8624229?dopt=AbstractPlus
42. Ellepola AN, Samaranayake LP. The effect of brief exposure to sub- therapeutic concentrations of chlorhexidine gluconate on the germ tube formation of oral Candida albicans and its relationship to post- antifungal effect. Oral Dis. 2000; 6:166-71. http://www.ncbi.nlm.nih.gov/pubmed/10822360?dopt=AbstractPlus
43. Forgie AH, Paterson M, Pine CM. A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high- caries-risk adolescents. Caries Res. 2000; 34:432-9. http://www.ncbi.nlm.nih.gov/pubmed/11014911?dopt=AbstractPlus
44. Francetti L, del Fabbro M, Testori T et al. Chlorhexidine spray versus chlorhexidine mouthwash in the control of dental plaque after periodontal surgery. J Clin Periodontol. 2000; 27:425-30. http://www.ncbi.nlm.nih.gov/pubmed/10883872?dopt=AbstractPlus
45. Garvey LH, Roed-Petersen J, Husum B. Anaphylactic reactions in anaesthetised patients—four cases of chlorhexidine allergy. Acta Anaesthesiol Scand. 2001; 45:1290-4. http://www.ncbi.nlm.nih.gov/pubmed/11736685?dopt=AbstractPlus
46. Grossman E, Meckel AH, Isaacs RL et al. A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanquinarine on dental plaque and gingivitis. J Periodontol. 1989; 60:435-40. http://www.ncbi.nlm.nih.gov/pubmed/2689627?dopt=AbstractPlus
47. Knight BA, Puy R, Douglass J et al. Chlorhexidine anaphylaxis: a case report and review of the literature. Intern Med J. 2001; 31:436-7. http://www.ncbi.nlm.nih.gov/pubmed/11584911?dopt=AbstractPlus
48. Lauerma AI. Simultaneous immediate and delayed hypersensitivity to chlorhexidine digluconate. Contact Derm. 2001; 44:59. http://www.ncbi.nlm.nih.gov/pubmed/11156034?dopt=AbstractPlus
49. MacNeill S, Rindler E, Walker A et al. Effects of tetracycline hydrochloride and chlorhexidine gluconate on Candida albicans. An in vitro study. J Clin Periodontol. 1997; 24:753-60. http://www.ncbi.nlm.nih.gov/pubmed/9350560?dopt=AbstractPlus
50. Soskolne WA, Chajek T, Flashner M et al. An in vivo study of the chlorhexidine release profile of the PerioChip in the gingival crevicular fluid, plasma and urine. J Clin Periodontol. 1998; 25:1017-21 http://www.ncbi.nlm.nih.gov/pubmed/9869352?dopt=AbstractPlus
51. Beiswanger BB, Mallat ME, Jackson RD et al. Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing. J Clin Dentistry. 1992; 3:33-8.
52. Jenkins S, Addy M, Wade W et al. The magnitude and duration of the effects of some mouthrinse products on salivary bacterial counts. J Clin Periodontol. 1994; 21:397-401. http://www.ncbi.nlm.nih.gov/pubmed/8089241?dopt=AbstractPlus
53. Baqui AAMA, Kelley JI, Jabra-Rizk MA et al. In vitro effect of oral antiseptics on human immunodeficiency virus-1 and herpes simplex virus type 1. J Clin Periodontol. 2001; 28:610-16. http://www.ncbi.nlm.nih.gov/pubmed/11422581?dopt=AbstractPlus
54. Block C, Robenshtok E, Simhon A et al. Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis using a surface test. J Hosp Infect. 2000; 46:147-52. http://www.ncbi.nlm.nih.gov/pubmed/11049709?dopt=AbstractPlus
55. Suller MTE, Russell AD. Antibiotic and biocide resistance in methicillin- resistant Staphylococcus aureus and vancomycin-resistant enterococcus. J Hosp Infect. 1999; 43:281-91. http://www.ncbi.nlm.nih.gov/pubmed/10658804?dopt=AbstractPlus
56. Kampf G, Hofer M, Wendt C. Efficacy of hand disinfectants against vancomycin-resistant enterococci in vitro. J Hosp Infect. 1999; 42:143-50. http://www.ncbi.nlm.nih.gov/pubmed/10389064?dopt=AbstractPlus
57. Kampf G, Jarosch R, Ruden H. Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect. 1998; 38:297-303. http://www.ncbi.nlm.nih.gov/pubmed/9602978?dopt=AbstractPlus
58. Greenstein G, Tonetti M and the Research, Science et al. Position Paper. The role of controlled drug delivery for periodontitis. J Periodontol. 2000; 71:125-40. http://www.ncbi.nlm.nih.gov/pubmed/10695948?dopt=AbstractPlus
59. Meiller TF, Kelley JI, Jabra-Rizk MA et al. In vitro studies of the efficacy of antimicrobials against fungi. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91:663-70.
60. Rabe LK, Hillier SL. Effect of chlorhexidine on genital microflora, Neisseria gonorrhoeae, and Trichomonas vaginalis in vitro. Sex Transm Dis. 2000; 74-8.
61. Goroncy-Bermes P, Schouten MA, Voss A. In vitro activity of a nonmedicated handwash product, chlorhexidine, and an alcohol-based hand disinfectant against multiply resistant gram-positive microorganisms. Infect Control Hosp Epidemiol. 2001; 22:194-6. http://www.ncbi.nlm.nih.gov/pubmed/11379706?dopt=AbstractPlus
62. Ellepola ANB, Samaranayake LP. Adjunctive use of chlorhexidine in oral candidosis: a review. Oral Dis. 2001; 7:11-7. http://www.ncbi.nlm.nih.gov/pubmed/11354914?dopt=AbstractPlus
63. Okano M, Nomura M, Hata S et al. Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989; 125:50-2. http://www.ncbi.nlm.nih.gov/pubmed/2910207?dopt=AbstractPlus
64. Snellman E, Rantanen T. Severe anaphylaxis after a chlorhexidine bath. J Am Acad Dermatol. 1999; 40:771-2. http://www.ncbi.nlm.nih.gov/pubmed/10321611?dopt=AbstractPlus
65. Yong D, Parker FC, Foran SM. Severe allergic reactions and intra- urethral chlorhexidine gluconate. Med J Aust. 1995; 162:257-8. http://www.ncbi.nlm.nih.gov/pubmed/7891607?dopt=AbstractPlus
66. Evans RJ. Acute anaphylaxis due to topical chlorhexidine acetate. BMJ. 1992; 304:686. http://www.ncbi.nlm.nih.gov/pubmed/1571641?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1881536&blobtype=pdf
67. Chisholm DG, Calder I, Peterson D et al. Intranasal chlorhexidine resulting in anaphylactic circulatory arrest. BMJ. 1997; 315:785. http://www.ncbi.nlm.nih.gov/pubmed/9345172?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2127534&blobtype=pdf
68. Terazawa E, Shimonaka H, Nagase K. Severe anaphylactic reaction due to a chlorhexidine-impregnated central venous catheter. Anesthesiology. 1998; 89:1296-8. http://www.ncbi.nlm.nih.gov/pubmed/9822040?dopt=AbstractPlus
69. Oda T, Hamasaki J, Kanda N et al. Anaphylactic shock induced by an antiseptic-coated central venous catheter. Anesthesiology. 1997; 87:1242-3. http://www.ncbi.nlm.nih.gov/pubmed/9366479?dopt=AbstractPlus
70. Nicoletti G, Boghossian V, Gurevitch F et al. The antimicrobial activity in vitro of chlorhexidine, a mixture of isothiazolinones (‘Kathon’ CG) and cetyl trimethyl ammonium bromide (CTAB). J Hosp Infect. 1993; 23:87-111. http://www.ncbi.nlm.nih.gov/pubmed/8097222?dopt=AbstractPlus
71. Rikimaru T, Kondo M, Kondo S et al. Efficacy of common antiseptics against mycobacteria. Int J Tuberc Lung Dis. 2000; 4:570-6. http://www.ncbi.nlm.nih.gov/pubmed/10864189?dopt=AbstractPlus
72. Odore R, Colombatti Valle V, Re G. Efficacy of chlorhexidine against some strains of cultured and clinically isolated microorganisms. Vet Res Commun. 2000; 24:229-38. http://www.ncbi.nlm.nih.gov/pubmed/10836268?dopt=AbstractPlus
73. Regent Medical. Information sheet for Hibiclens (chlorhexidine gluconate) antiseptic/antimicrobial skin cleanser. From website (http://www.regentmedical.com).
74. Lampe MF, Ballweber LM, Stamm WE. Susceptibility of Chlamydia trachomatis to chlorhexidine gluconate gel. Antimicrob Agents Chemother. 1998; 42:1726-30. http://www.ncbi.nlm.nih.gov/pubmed/9661012?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=105674&blobtype=pdf
75. Regent Medical. Material safety data sheets for Hibiclens chlorhexidine gluconate). From website (http://www.regentmedical.com).
76. American Academy of Periodontology, Committee on Research, Science and Therapy. Chemical agents for the control of plaque and gingivitis. American Academy of Periodontology; Chicago IL, 1994 Apr.
77. Dexcel Pharma, Edison, NJ: Personal communication.
78. Colgate Oral Pharmaceuticals, Canton, MA: Personal communication.
79. Stabholz A, Shapira L, Maher D et al. Using the PerioChip in treating adult periodontitis: an interim report. Compend Contin Educ Dent. 2000; 21:325-34. http://www.ncbi.nlm.nih.gov/pubmed/11199684?dopt=AbstractPlus
80. Reviewers’ comments (personal observations).
81. Karpinia K, Magnusson I, Biesbrock AR et al. The effectiveness of two different battery-powered toothbrushes on whitening through removal of stain. J Clin Dent. 2002; 13:215-8. http://www.ncbi.nlm.nih.gov/pubmed/12518493?dopt=AbstractPlus
82. Garcia-Godoy F, Ellacuria J. Effectiveness of sonicare power toothbrush to remove chlorhexidine stains. Am J Dent. 2002; 15:290-2. http://www.ncbi.nlm.nih.gov/pubmed/12572650?dopt=AbstractPlus
83. De Soet JJ, Gruythuysen RJ, Bosch JA et al. The effect of 6-monthly application of 40% chlorhexidine varnish on the microflora and dental caries incidence in a population of children in surinam. Caries Res. 2002; 36:449-55. http://www.ncbi.nlm.nih.gov/pubmed/12459619?dopt=AbstractPlus
84. Baca P, Munoz MJ, Bravo N et al. Effectiveness of chlorhexidine-thymol varnish for caries reduction in permanent first molars of 6-7-year-old children: 24-month clinical trial. Community Dent Oral Epidemiol. 2002; 30:363-8. http://www.ncbi.nlm.nih.gov/pubmed/12236827?dopt=AbstractPlus
85. Houston S, Hougland P, Anderson JJ. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care. 2002; 11:567-70. http://www.ncbi.nlm.nih.gov/pubmed/12425407?dopt=AbstractPlus
86. Genuit T, Bochicchio G, Napolitano LM et al. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect. 2001; 2:5-18.
87. Brooks SE, Walczak MA, Hameed R et al. Chlorhexidine resistance in antibiotic-resistant bacteria isolated from the surfaces of dispensers of soap containing chlorhexidine. Infect Control Hosp Epidemiol. 2002; 23:692-5. http://www.ncbi.nlm.nih.gov/pubmed/12452299?dopt=AbstractPlus
88. Pistorius A, Willershausen B. Cases of HIV-associated characteristic periodontal disease. Eur J Med Res. 1999; 4:121-5. http://www.ncbi.nlm.nih.gov/pubmed/10085280?dopt=AbstractPlus
89. American Academy of Periodontology, Committee on Research, Science and Therapy. Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. J Periodontol. 2001; 72:1790-800 http://www.ncbi.nlm.nih.gov/pubmed/11811516?dopt=AbstractPlus
90. Sunstar Americas. Paroex (chlorhexidine gluconate) oral rinse 0.12% prescribing information. Schaumburg, IL; 2015 Sep.
91. Colgate Oral Pharmaceuticals. PerioGard (chlorhexidine gluconate) alcohol free oral rinse USP, 0.12% prescribing information. New York, NY; 2014 Jan.
92. US Food and Drug Administration. FDA drug safety communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2017 Feb 2. From FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm530975.htm
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