The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations
DOI:
https://doi.org/10.24959/cphj.21.1543Abstract
Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes.
Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations.
Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary.
Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms.
Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy
References
Kane, S. P. (n.d.). Chlorhexidine. ClinCalc DrugStats Database, Version 21.1. ClinCalc.com. Available at: https://clincalc.com/DrugStats/Drugs/Chlorhexidine.
Fiorillo, L. (2019) Chlorhexidine gel use in the oral district: A systematic review. Gels, 5 (2), 31. doi: https://doi.org/10.3390/gels5020031.
James, P., Worthington, H. V., Parnell, C., Harding, M., Lamont, T., Cheung, A. et al. (2017). Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database of Systematic Reviews, 3 (3). doi: https://doi.org/10.1002/14651858.CD008676.pub2.
George, J., Klika, A. K., Higuera, C. A. (2017). Use of chlorhexidine preparations in total joint arthroplasty. Journal of bone and joint infection, 2 (1), 15-22. doi: https://dx.doi.org/10.7150%2Fjbji.16934.
Privitera, G. P., Costa, A. L., Brusaferro, S., Chirletti, P., Crosasso, P., Massimetti, G. et al. (2017). Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: a systematic review and meta-analysis. American Journal of Infection Control, 45 (2), 180-189. doi: https://doi.org/10.1016/j.ajic.2016.09.017.
Merani, R., McPherson, Z. E., Luckie, A. P., Gilhotra, J. S., Runciman, J., Durkin, S. et al. (2016). Aqueous chlorhexidine for intravitreal injection antisepsis: a case series and review of the literature. Ophthalmology, 123 (12), 2588-2594. doi: https://doi.org/10.1016/j.ophtha.2016.08.022.
Frost, S. A., Alogso, M. C., Metcalfe, L., Lynch, J. M., Hunt, L., Sanghavi, R. et al. (2016). Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Critical Care, 20 (1). doi: https://doi.org/10.1186/s13054-016-1553-5.
Semrau, K. E., Herlihy, J., Grogan, C., Musokotwane, K., Yeboah-Antwi, K., Mbewe, R. et al. (2016). Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial. The Lancet Global Health, 4 (11), 827-836. doi: https://doi.org/10.1016/S2214-109X(16)30215-7.
Gilbert, P., Moore, L. E. (2005). Cationic antiseptics: diversity of action under a common epithet. Journal of applied microbiology, 99 (4), 703-715. doi: https://doi.org/10.1111/j.1365-2672.2005.02664.x.
Cabinet of Ministers of Ukraine. (2020). Decree № 224 dated 20.03.2020 «Pro zatverdzhennya pereliku likarskykh zasobiv, medychnykh vyrobiv ta/abo medychnoho obladnannya, neobkhidnykh dlya zdiysnennya zakhodiv, spryamovanykh na zapobihannya vynyknennyu i poshyrennyu, lokalizatsiyu ta likvidatsiyu spalakhiv, epidemiy ta pandemiy koronavirusnoyi khvoroby (COVID-19), yaki zvilnyayutsya vid splaty vviznoho myta ta operatsiyi z vvezennya yakykh na mytnu terytoriyu Ukrayiny zvilnyayutsya vid opodatkuvannya podatkom na dodanu vartist». kmu.gov.ua. Available at: https://www.kmu.gov.ua/npas/pro-zatverdzhennya-pereliku-likarskih-zasobiv-medichnih-virobiv-taabo-224200320.
Kampf, G. (2016). Acquired resistance to chlorhexidine – is it time to establish an ‘antiseptic stewardship’initiative? Journal of Hospital Infection, 94 (3), 213-227.doi: https://doi.org/10.1016/j.jhin.2016.08.018.
Sunstar Americas Inc. Issues Voluntary Nationwide Recall of Paroex® Chlorhexidine Gluconate Oral Rinse USP, 0.12% Due to Microbial Contamination. fda.gov. Available at: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/sunstar-americas-inc-issues-voluntary-nationwide-recall-paroexr-chlorhexidine-gluconate-oral-rinse.
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