Chlorhexidine

Generic name
Chlorhexidine
Brand name
ATC Code
D08AC02
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Chlorhexidine

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

The absorption after application on the skin is lower than 0.01%, probably because of the strong binding to proteins.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Disinfection of the skin
  • Cutaneous
    • Extremely premature infants Gestational age < 27 weeks
      [2] [3] [4]

      • Chlorhexidine 2 mg/ml without alcohol: apply around the navel and the skin around the navel if necessary during the first 5 days of life.

        Also in children with other skin abnormalities (epidermolysis bullosa, SSSS)

    • 0 years up to 18 years
      [1]

      • ChloraPrep: solution 20 mg/ml, in combination with isopropanol:rub into the skin using applicator for 30 sec.
        Powder 0,5 %: Apply to affected skin once or more times daily. Maximum duration of use:4 weeks

      • Caution is needed when applying it to neonates – premature neonates in particular – because chemical burns can occur.

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Chemical burns in neonates (premature in particular).

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Do not apply the 5-20 mg/ml solution combined with isopropanol and the 0.15 mg/ml solution in combined with cetrimide in children aged less than 2 months due to the risk of chemical burns.

Do not use a cloth impregnated with the 20 mg/ml solution and the 40 mg/ml solution on premature babies, babies with a low birthweight, babies aged less than 2 months or babies receiving phototherapy. Do not use around the eyes, ears, mouth, on open wounds or damaged skin, and do not use immediately before invasive surgery.

 

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

The use of alcoholic and aqueous chlorhexidine solutions for skin disinfection prior to invasive procedures is related to chemical burns in neonates, especially in premature infants (especially after a pregnancy of < 32 weeks) and in the first 2 weeks after birth.

Risk risk of sensitization:
Do not use if you have a history of an allergic reaction to chlorhexidine. The risk of sensitization is greater with damaged skin, young children, application to a large skin area or due to insufficient post-operative cleaning of the surgical area.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

ANTISEPTICS AND DISINFECTANTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

  1. CareFusion U.K. 244 Ltd., SmPC Chloraprep (RVG 110531) 14-01-2016, www.geneesmiddeleninformatiebank.nl
  2. Sankar MJ et al, Does skin cleansing with chlorhexidine affect skin condition, temperature and colonization in hospitalized preterm low birth weight infants?: a randomized clinical trial, J. Perinatol, 2009, Dec;29(12), 795-801
  3. Mullany LC et al, A randomized controlled trial of the impact of chlorhexidine skin cleansing on bacterial colonization of hospital-born infants in Nepal., Pediatr Infect Dis J., 2008, Jun;27(6), 505-11
  4. Watkins AM et al, Alcohol burns in the neonate, J Paediatr Child Health. , 1992, Aug;28(4), 306-8

Changes

Therapeutic Drug Monitoring


Overdose