Chlorhexidine

RE: Chlorhexidine

Delia Richter — Fri, 27 Nov 2020 10:55:43 GMT

'Or is it more that the shampoos also contain emollients to counteract the drying effect of the chlorhex/ detergent? '

Could well be!

RE: Chlorhexidine

Chris Geddes — Thu, 26 Nov 2020 09:51:11 GMT

[quote userid="6550" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29518/chlorhexidine/226967#226967"]I cannot find any POM-V chlorhexidine shampoos nor any licenced products without the likes of ketoconizole.[/quote]

Look harder ;)

www.animeddirect.co.uk/microbex-shampoo-200ml

RE: Chlorhexidine

Lucy Fleming — Wed, 25 Nov 2020 17:02:58 GMT

[quote userid="3074" url="~/001/veterinary-clinical/small-animal/dermatology/f/discussions/29518/chlorhexidine/226968#226968"]I wonder if it's the base in the hibiscrub that can cause issues?[/quote]

Or is it more that the shampoos also contain emollients to counteract the drying effect of the chlorhex/ detergent?

If you particularly wanted one, we use quite a few of the Vetruus products. Clorexyderm 4% shampoo is just chlorhex and emollients. I believe their Peptivet shampoo also has chlorhexidine, though I can't remember what else. I don't think either are POM-V though (*please bear in mind flawed memory and I'm too lazy to walk to dispensary to check the packaging)

RE: Chlorhexidine

Julian Earl — Tue, 24 Nov 2020 20:04:35 GMT

Tere are a lot of papers on Entrez PubMed about chlorhexine and canie pyoderma. Such as this one: Topical therapy for drug-resistant pyoderma in small animals - PubMed (nih.gov)

But a lot of links to other papers , clinical trials and others. I searched chlorhexidine and pyoderma and they all came up. I have not read them all I'm afraid so you will have to fid the conclusions yourself. Sorry!

RE: Chlorhexidine

Evelyn Barbour-Hill — Tue, 24 Nov 2020 18:44:13 GMT

I don't know if I'm missing something here. Hibiscrub is, to all intents and purposes, a shampoo. A mixture of chlorhexidine solution and a detergent.

What's happened to Hibitane, by the way? Can't get it, or any equivalent. Does anybody know of one?

RE: Chlorhexidine

Bob Russell — Tue, 24 Nov 2020 11:38:44 GMT

We don't use Hibiscrub but do use Vetasept. My hands used to take a pounding with Hibiscrub so for a bit I used Pevidine. When I used it more recently I did not get the same reaction.

I was in mixed practice so hands did get cold in the winter which did not help.

It may be a brand/formulation issue but as we are using these formulations as surgical scrubs they cannot be that irritant.

If people think the shampoo formulations are better then they should use them but we have used Vetasept uneventfully for decades. The key is to make sure they are all thoroughly rinsed out.

RE: Chlorhexidine

Delia Richter — Tue, 24 Nov 2020 11:18:50 GMT

Hiya, I think there's plenty of good evidence that 2 - 4 % chlorhexidine shampoos are effective:

https://veterinaryrecord-bmj-com.liverpool.idm.oclc.org/content/167/14/532

https://veterinaryrecord-bmj-com.liverpool.idm.oclc.org/content/170/26/675

https://veterinaryrecord-bmj-com.liverpool.idm.oclc.org/content/169/10/249

I wonder if it's the base in the hibiscrub that can cause issues? I coudn't find any evidence one way or another for this, but anecdotally I do feel that the shampoos are 'nicer' on the skin. ICADA recommend a non-irritating shampoo in CAD, which is often the underlying cause of skin bacterial overgrowth (Olivry et al., 2010 and 2015).

There are shampoos formulated to not upset the skin barrier as well (Nuttall, 2020).

Apologies for the hasty references!

Cheers,

Delia

Nuttall, T. (2020) 'Topical therapy in canine atopic dermatitis: new products' Companion Animal 25, 76-82

Olivry T, DeBoer DJ, Favrot C et al; International Committee on Allergic Diseases of Animals. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Vet Res. 2015;11:210. doi: 10.1186/s12917-015-0514-6

Olivry T, DeBoer DJ, Favrot C; International Committee on Allergic Diseases of Animals. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Vet Dermatol. 2010;21(3):233–248. doi: 10.1111/j.1365-3164.2010.00889.x

RE: Chlorhexidine

Bob Russell — Tue, 24 Nov 2020 09:58:55 GMT

I cannot find any POM-V chlorhexidine shampoos nor any licenced products without the likes of ketoconizole.

I cannot therefore see the issue with licensing. Most practices routinely use a 4% chlorhexidine for hand washing and patient preparation.

RE: Chlorhexidine

Judith Joyce — Tue, 24 Nov 2020 09:25:48 GMT

I think there are a couple of issues with the use of chlorhexidine.

I believe that there is data on file to support the antifungal and antimicrobial use of the licensed products, as well as peer reviewed papers.

I have seen reactions - admittedly owners appear to be better at putting thing on than rinsing them off, slippery dogs can be pretty difficult to rinse. I agree contact time and rinsing are important as is degreasing but that can lead to excess drying of the skin with more concentrated chlorhexidine solutions

Should we be using more concentrated chlorhexidine solutions off label when there are licensed products available for the purpose?

RE: Chlorhexidine

Bob Russell — Tue, 24 Nov 2020 09:16:20 GMT

Not sure what the issue is with dispensing chlorhexidine for use as a shampoo is?

Using it diluted as a shampoo is unlikely to be adequate for antimicrobial or anti fungal effects. Both concentration and contact time matter.

I was at some CPD (in the days when you could go for CPD) and the dermatologist was suggesting as close to 4% on the skin as possible. This makes the 2% shampoo a potential problem.

I have rarely seen any reaction or side effect following application, ten minutes contact time followed by thorough rinsing.

Concerns regarding bugs becoming tolerant to chlorhexidine are likely to be greater with dilution and repeated use but much less of an issue than dishing out weeks of antibiotics?

I await re-education!!

RE: Chlorhexidine

Judith Joyce — Mon, 23 Nov 2020 12:47:10 GMT

Hi Delia,

I'm probably showing my age and grinding an old axe on the basis of doing no harm and allowing skin to heal. In the old days it seemed a common practice to dispense concentrated Hibiscrub with an instruction to the owner to dilute it until it was 'pale pink' and use as a shampoo. Especially in intertriginous areas it not infrequently resulted in a reaction. Since the standardised 2 and 3% chlorhexidine gluconate containing shampoos have been licensed I don't think its justified to dispense Hibiscrub for the purpose, although the custom seems to have persisted for a while on cost grounds.