Antiseptics &

Disinfectants

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-:Introduction:-Antimicrobial:- the substances derived from natural or

synthetic sources that kills or inhibit the growth of micro-organism such as bacteria, fungi, protozoas

Germicides:- a group of drugs that are able to inhibit the growth, development or leads to death of microorganisms in the environment surrounding the patient or on the surface of the body.

Specially agents which inhibits or kills microbes on contact

They have low margin of safety Non-systemic use Non selective Antimicrobial agents

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Germicides Germicides

ANTISEPTICS DISINFECTANTS

ANTISEPTICS:-ANTISEPTICS:- (Anti= (Anti= against; septicas – emitting a fetid smell)Chemical substances which are used to destroy, inhibit pathogenic bacteria (not the spores) on animate (living) surface such as skin, eye, mucous membranes(as in mouth washes).1879- Lister- Father of ‘Antiseptic surgery’They falls under “ Drug Control Agency of the Government”

DISINFECTANTS• Chemical substances or germicides which are use to destroy

or inhibit the growth of pathogenic vegetative bacteria (not their spores) on inanimate(non-living) surface such as glassware's or surgical instruments.

e.g.- Formaldehyde, phenol, ethyl alcohol, soaps.

They falls under “Control of Environmental protection agency of the Government”

They process “concentration dependent killing” Antiseptics & Disinfectant are often added to easily

available every day utilities like soaps,toothpastes,mouth wash, after saving lotion.

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-:Some ancillary terms:- 1.Sterilization:- Definition:- freeing an article, a surface or a medium by

removing or killing all micro-organisms including vegetative bacteria, Spores, fungi & viruses

usually sterilization is affected by autoclaving at 15lb pressure of stream at 120oC for atleast 30 min

[It is the ultimate goal of any infection control protocol]

Other methods also include-o Infra-red(IR)-radiation, o Ultraviolet(UV)-radiation o γ-radiation

2. Decontamination:- Marketed destruction of viable pathogenic organisms to a

level that will allow a healthy person’s natural defenses to prevent any infection.

e.g.- Decontamination of water

3.Sanitisation:- reduction In microbial load from an inanimate surface to a level set forth by public health Department of Environmental Agency

These levels are considered acceptable for the health of the population

4. Pasteurisation:-Process of heating milk or other liquids or semisolids for

about 30 min at 60-80oC which kills the non-sporulating microorganism and prevents the growth of food-borne pathogens for a specific period of time.

5.Preservation:- To preserve the efficacy & to prevent the deterioration of

the drug formulation up to its expiry period.

A Preservatives may protect the drug from oxidation.

e.g.-Benzyl Alcohol(2%),Benzoic Acid & its salts (0.2%)

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-:-:IDEAL Antiseptics/DisinfectantIDEAL Antiseptics/Disinfectant:- :- • High Efficacy:High Efficacy:– Broad spectrum / sporicidal / kill all formsBroad spectrum / sporicidal / kill all forms– Rapid onset / long duration actionRapid onset / long duration action– Cidal not static– Active in presence of blood, pus,exudates and

excreta– No Resistance

• Non Toxic:Non Toxic:– Non-irritating to tissues,should not delay healing.– Non absorbable / No hypersensitivity– Chemically stable.Chemically stable.

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IDEAL ANTISEPTICS :IDEAL ANTISEPTICS :• Added Advantage:-– Non-staining with agreeable color and odour– Could be added to soaps– Non corrosive.

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MECHANISM OF ACTION:

1. Oxidation of Bacterial protoplasm.

e.g.- KMn04, H202, Halogens

2.Denaturation of Bacterial Proteins & Enzyme

e.g.-Phenols, Chlorhexidine, Alcohol, Aldehyde

3.Detergent like action increasing permeability of bacterial membrane

e.g.- Soaps,Cetrimide

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FACTORS MODIFYING ACTIONFACTORS MODIFYING ACTION• TEMPERATURE AND pH.

• PERIOD OF CONTACT WITH MICROBES.

• NATURE OF MICROBES INVOLVED.

• SIZE OF INNOCULUM

• PRESENCE OF BLOOD,PUS,OR ORGANIC MATTER.

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General Uses of Antiseptics/ Disinfectants

• Asepsis before injections:-

• Surgical Uses:- – Asepsis before surgery

– Scrubbing

– Sterilization of the surgical instruments

• Cuts, wounds & Lacerations

• Disinfection of Hospital premises

• Water purification & domestic disinfection

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CLASSIFICATIONCLASSIFICATION :-:-‘PHAARMA GOD’• PHENOL DERIVATIVES:-

Phenol,Cresol,Hexylresorcinol,HexachlorophenePhenol,Cresol,Hexylresorcinol,Hexachlorophene• HALOGENS:-Iodine, Iodophores, Chlorine, ChlorophoresIodine, Iodophores, Chlorine, Chlorophores

• ALCOHOLS:-ethanol , Isopropanol.:-ethanol , Isopropanol.

• ALDEHYDES:- :- Formaldehyde, GlutaraldehydeFormaldehyde, Glutaraldehyde• SUSURRFACE ACTIVE AGENTS:-FACE ACTIVE AGENTS:- • QUATERNARY AMMONIUM (CATIONIC):-

Cetrimide, Benzalkonium chloride, Dequalinium chloride. BIGUANIDE:- Chlorhexidine • SOAPS:- OF sodium & Potassium

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• MMETALLIC SALTSETALLIC SALTS:- :- Silver nitrate, Silver sulfadiazine, Mild silver protein, Zinc sulfate, Calamine, Zinc oxide.

• AACIDSCIDS:- :- Boric acid, Acetic acid

• GGASESASES:- :- Ethylene oxide Ethylene oxide

• OOXIDIZING AGENTSXIDIZING AGENTS:- :- KMnoKMno44,,Hydrogen peroxide, Benzoyl peroxide

• DDYESYES:- GENTIAN VIOLET, METHYLENE BLUE

BRILIANT GREEN, ACRIFLAVIN AND PROFLAVIN

• MMISCELLANEOUSISCELLANEOUS:-:- NITROFURAZONE NITROFURAZONE

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PHENOL DERIVATIVESPHENOL DERIVATIVES::• PHENOL (CARBOLIC ACID):-• One of the earliest used Antiseptics & still the standard for

comparing other germicides.

• Weak agents Static at- 0.2% Bactericidal at >1%,

• Poor action bacterial spore • Protoplasmic poison Protoplasmic poison MOA:- Denatured bacterial protein (irritant/toxic to tissues)(irritant/toxic to tissues)-Mild LA action- use as Antipruritic Preparation -Mild LA action- use as Antipruritic Preparation USESUSES: : Disinfectant of Urine,faeces pus,sputum,antipruritic Disinfectant of Urine,faeces pus,sputum,antipruritic

preparation mouth wash.preparation mouth wash.

Side effectSide effect:-Buccal, esophageal, gastric burns, scars/strictures:-Buccal, esophageal, gastric burns, scars/strictures

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CRESOL (METHYL PHENOL):-• X3 potent than Phenol / less damage to tissuesX3 potent than Phenol / less damage to tissues• USES:-USES:- Disinfecting of utensils, Excreta, for washing Disinfecting of utensils, Excreta, for washing

hands, irrigation of root canals.hands, irrigation of root canals.CHLOROXYLENOL(DETTOL):-• Non-corrosive, Non-irritating to intact skin, Non-corrosive, Non-irritating to intact skin, No stain,No stain, 4.8% commercial use “Dettol”(9% terpinol+13% Alcohol)4.8% commercial use “Dettol”(9% terpinol+13% Alcohol) 6.25%- Instruments6.25%- Instruments Cream & Soap,Cream & Soap, Lubricating obstetric cream (1.4% ). Lubricating obstetric cream (1.4% ). • USESUSES:-:-Surgical Antiseptics , skin cream, mouth wash, soaps, wounds Surgical Antiseptics , skin cream, mouth wash, soaps, wounds

& cuts& cuts

• HEXACHLOROPHENE:• POTENT CHLORINATED PHENOLPOTENT CHLORINATED PHENOL

• Odourless, non staining, non irritant (+soaps)Odourless, non staining, non irritant (+soaps)

• Sustained actionSustained action

• Good- Gm+ve/ Poor- Gm-ve & sporesGood- Gm+ve/ Poor- Gm-ve & spores

• USESUSES:- ANTISEPTICS FOR SURGICAL SCRUB, ANTISEPTICS FOR SURGICAL SCRUB, TOILET PRODUCTS & DEODRANTS, Skin infections TOILET PRODUCTS & DEODRANTS, Skin infections (Furunculosis/ Carbuncle), baby bath products (<2%).(Furunculosis/ Carbuncle), baby bath products (<2%).

• Side effect:- Neurotoxicity (Neonates)->2%- BAN.Neurotoxicity (Neonates)->2%- BAN.

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Phenol Derivatives (contd.)• Triclosan:-uses- Liquid soaps, Dentifrices, mouth wash

• Thymol:-

– Antiseptic / mild LA effect

– Uses- cough drops / Dentifrices / Acne / mouth wash

• Resorcinol- less potent than Phenol

• Uses- Antiseptic (ringworm, acne, ), keratolytic & antipruritic effect (Seborrhoeic dermatitis, Eczema, Psoriasis

• Hexylresorcinol- mouthwash

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Contains are menthol, thymol,methyl salicylate, and eucalyptol

OXIDIZING AGENTS:-OXIDIZING AGENTS:-• POTASSIUM PERMAGNATE:-• HIGHLY WATER SOLUBLE.HIGHLY WATER SOLUBLE.• Nascent [O]-OXIDIZES BACTERIAL PROTOPLASMNascent [O]-OXIDIZES BACTERIAL PROTOPLASM..

USESUSES:- :- 1:4000-1:10,000 SOLN (1:4000-1:10,000 SOLN (CONDY’S LOTIONCONDY’S LOTION)-)-– Antiseptic(Mouthwash/GARGLING/DOUCHING, IRRIGATING Antiseptic(Mouthwash/GARGLING/DOUCHING, IRRIGATING

CAVITIES/ wounds/ Atheletes foot (1%)CAVITIES/ wounds/ Atheletes foot (1%)– Domestic use-DISINFECTION OF utensils/ vegetables/ fruits/ Domestic use-DISINFECTION OF utensils/ vegetables/ fruits/

purification of WATER (ponds/ wells)purification of WATER (ponds/ wells)– GASTRIC LAVAGE (in alkaloidal poisoning)GASTRIC LAVAGE (in alkaloidal poisoning)– Styptic (5%)Styptic (5%)

• Side effectSide effect:-:- BURNS,BLISTERING /stain / Rusting / BURNS,BLISTERING /stain / Rusting / sensitve to light.sensitve to light.

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OXIDIZING AGENTS:OXIDIZING AGENTS:HH22OO22 – – Adv.-

– Non-toxic/ colorless/ odourless– Effective against anaerobic bacteria

• Demerits-– Weak antiseptic– To be kept in dark bottles

• Uses-– Dental use- Mouthwash (3%)- dilute with water- stomatitis/ cavity

preparation– Bleaching agent (for teeth stains)- 30% H2O2 + glycerine+ pumice– Surgical use (3-6%)- wound cleaning / slough remove– Removal of ear wax– Deodorant– Styptic (25-30%)

• BENZOYL PEROXIDE:-

• Liberate 0Liberate 022,killsAnerobic,microaerophilic bacteria ,killsAnerobic,microaerophilic bacteria Keratolytic & comedolytic properties-Keratolytic & comedolytic properties-(To remove warts and other lesions in which the epidermis produces excess skin)

• USESUSES:-:-ACNE (2.5-10% cream), ANTISEPTICSACNE (2.5-10% cream), ANTISEPTICS..

ADVERSE EFFECTSADVERSE EFFECTS:-:-

Burning,stinging sensation,localized erythmia,dryness of skin,SCALING EDEMA.

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HALOGENS:HALOGENS:-

IODINE & I- releasing agents:

• Rapid action

• Broad spectrum

• Not readily inactivated by organic matter

• MICROBICIDAL MICROBICIDAL AGENT, IODINATES AGENT, IODINATES AND OXIDIZES AND OXIDIZES MICROBIAL MICROBIAL PROTOPLASMPROTOPLASM

Chlorine & Cl- releasing agents:

• Rapid action

• Broad spectrum

• readily inactivated by organic matter

• MICROBICIDAL MICROBICIDAL AGENT, AGENT, CHLORINATES AND CHLORINATES AND OXIDIZES OXIDIZES MICROBIAL MICROBIAL PROTOPLASMPROTOPLASM

HALOGENS:HALOGENS:-• IODINE:USES:USES: ( (1:20,000 , SOLN KILL VEGETATIVE FORM- ANTISEPTIC 1:20,000 , SOLN KILL VEGETATIVE FORM- ANTISEPTIC

USES) USES) 1.TINCTURE IODINE (2.5% IN ALCOHOL) 1.TINCTURE IODINE (2.5% IN ALCOHOL) 2.MANDL’S THROAT PAINT 2.MANDL’S THROAT PAINT (1.25% IN POT .IODIDE) FOR (1.25% IN POT .IODIDE) FOR

SORE THROAT.SORE THROAT. 3.COUNTER IRRITANT3.COUNTER IRRITANT 4. WATER PURIFICATION4. WATER PURIFICATION..

ADRsADRs: : CORROSIVE,BURNS,BLISTERS, RASHES, stain, CORROSIVE,BURNS,BLISTERS, RASHES, stain, irritant, less duration of actionirritant, less duration of action

• To be kept in dark colored bottles.To be kept in dark colored bottles.

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IODOPHORES:-• SOLUBLE COMPLEX OF IODINE.SOLUBLE COMPLEX OF IODINE.• Slow RELEASE of FREE IODINESlow RELEASE of FREE IODINE• NON-IRRITATING,NONTOXIC,Non stainingNON-IRRITATING,NONTOXIC,Non staining• USES:- USES:- POVIDONE IODINE (POLYVINYL POVIDONE IODINE (POLYVINYL

PYRROLIDONE Iodine)-PYRROLIDONE Iodine)-– FOR BOILS,FURUNCULOSIS,BURNS,OTITIS FOR BOILS,FURUNCULOSIS,BURNS,OTITIS

EXTERNA, ULCER,VAGINITIS,SURGICAL EXTERNA, ULCER,VAGINITIS,SURGICAL SCRUBBING,DISINFECTION OF ENDOSCOPIC SCRUBBING,DISINFECTION OF ENDOSCOPIC INSTRUMENTS, Tinea infections (5%- cream, solution, INSTRUMENTS, Tinea infections (5%- cream, solution, OintmentOintment

– Dental uses- Mouth wash/ Gargle (2%)Dental uses- Mouth wash/ Gargle (2%)– Analgesic (Iodine (4%) creams- analgesics}Analgesic (Iodine (4%) creams- analgesics}

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• CHLORINE:-

• HIGHLY REACTIVEHIGHLY REACTIVE

• POTENT GERMICIDEPOTENT GERMICIDE

• USESUSES: : DISINFECTION OF URBAN WATER SUPPLIES DISINFECTION OF URBAN WATER SUPPLIES (Cl(Cl22 gas- 0.2- 0.4ppm) gas- 0.2- 0.4ppm)

• CHLOROPHORES:-

• COMPOUND RELEASES hypochlorous.COMPOUND RELEASES hypochlorous.

• TYPES:-TYPES:-1.CHLORONATED LIME (BLEACHING POWDER)

• USES: USES: • Disinfection of drinking water,Disinfection of drinking water,

• Swimming poolSwimming pool

• SanitizerSanitizer

• Tooth stains removalTooth stains removal 26

2.SODIUM HYPOCHLORITE SOLN:-

USESUSES:(4-6%) DISINFECTANT IN DAIRIES FOR MILK CANS, Lab :(4-6%) DISINFECTANT IN DAIRIES FOR MILK CANS, Lab disinfectant, Biohazard Spill management, disinfectant, Biohazard Spill management, EQUIPMENTS,ANTISEPTIC,ROOT CANAL THERAPY, also used EQUIPMENTS,ANTISEPTIC,ROOT CANAL THERAPY, also used as Bleaching agent in dentistryas Bleaching agent in dentistry

• 3.DAKIN SOLN: DILUTE SOD. HYPOCHLORITE BUFFERED DILUTE SOD. HYPOCHLORITE BUFFERED

WITH BORIC ACIDWITH BORIC ACID..• 4.EUSOL: ( (chlorinated lime 1.25%+Boric acid).chlorinated lime 1.25%+Boric acid).• USESUSES:-:-

Dissolving pus,Dissolving pus,

Blood clots,Blood clots,

Necrotic matter,Necrotic matter,

Clean infected wound,Clean infected wound,

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-:QUATERNARY AMMONIUM(CATIONIC ANTISEPTICS):-

• Detergents,Cidal to bacteria, Fungal &viruses, non Detergents,Cidal to bacteria, Fungal &viruses, non irritating, mild keratolyticirritating, mild keratolytic..

• USESUSES:- :- Sanitizer, AntisepticsSanitizer, Antiseptics, Disinfectant for surgical , Disinfectant for surgical instrument, glovesinstrument, gloves..

• CETRIMIDE:-

• soapy powder with faint ,fishy odors soapy powder with faint ,fishy odors

• wound clearing from dirt ,skin disinfectant, wound clearing from dirt ,skin disinfectant,

• Anti-plaque agentAnti-plaque agent,,

• As antiseptics, Surgical instruments, utensil As antiseptics, Surgical instruments, utensil

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• Cetyl pyridinium Chloride- Cetyl pyridinium Chloride- mouth wash, mouth wash, antiplaque agentantiplaque agent, , LozengesLozenges

• Benzalkonium Chloride- Benzalkonium Chloride- storage of sterile surgical storage of sterile surgical instrumentsinstruments

• SOAPSSOAPS:-:-

• Anionic detergents, weak Antiseptics Anionic detergents, weak Antiseptics

• Sod. Or Pot. Salts of large chain fatty acidsSod. Or Pot. Salts of large chain fatty acids

• Emulsifying agents.Emulsifying agents.

• Affective against-gm+VeAffective against-gm+Ve

• USED FOR CLEANSING ACTIONUSED FOR CLEANSING ACTION

• Sodium Lauryl sulphateSodium Lauryl sulphate.

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-:CHLOROHEXIDINE:-• Cationic biguanide which highly Powerful, on-irritating, colorless,

odorless antiseptics

• Spectrum of activity:-

Active against gm+ve bacteria

Moderately active against –gm-ve bacteria

MOA:- Disrupt bacterial membrane.

• Effective in the presence of pus, blood, organic matter.

• Exhibits residual activity after repeated use

• Savlon liquid antiseptics:- Chlorhexidine gluconate 1.5% + cetrimide 3% exhibits enhanced efficacy

• Formulation available:- lotion,

Cream,

Washes, Aqueous solution 30

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(Savlon is a combination of Chlorhexidine gluconate & cetrimide)

USES:- Bath, Neonatal bath, surgical scrub, Dental use- mouthwash including candidiasis (0.1-0.2% mouth wash) Aqueous solution In mouth wash-↓dental plaque accumulation Obstetrics (1% cream) & skin antiseptics & clearing of

wounds(0.05% aqueous solution) Preoperative clearing of skin(0.5% solution in 70% alcohol) Anti-plaque agent(prevent periodic disease) In catheterisation & cystoscopy- gel (0.25%

chlorhexidine+xylocaine) Disinfection of hydrophilic contact lenses-0.002-0.005%

chlorhexidine

Side effects:- Yellow brown stain, Altered taste, mucosal soreness

-:ALCOHOLS:--:ALCOHOLS:-MOA- ppts bacterial proteins /cidal• ETHANOL:ETHANOL:• EFFECTIVE ANTISEPTIC on skin (not on muc.

Membrane) / rapid action• CLEANSING AGENT AT 40-90% CONC.• ADRs: BURNING SENSATION,INJURY, irritant on

Muc. membranes.• Uses- wounds/ cuts, degerming of skin before injections

(Isopropyl alcohol)

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ALDEHYDES:ALDEHYDES:

• MOA- DENATURES BACTERIAL PROTEINS.• PROTOPLASMIC POISON.• FORMALDEHYDE (Formalin): slow antiseptic,

broad spectrum, sporicidal• USES: Disinfection of surgical instruments (2-8%),Preservation of dead tissue samples (4% aqueous

Solution),fumigation, urinary antiseptic (Methenamine)• ADRs: ECZEMATOID REACTIONS, irritates,No oral

use.

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ALDEHYDES:ALDEHYDES:• GLUTARALDEHYDE: Sterilizing agents Less irritating Less pungent , Broad spectrum ,not inactivated by Bio fluids, Activated at alkaline pH.• USES:

1. Cold sterilization- Disinfection of surgical instruments , Endoscopes (to be kept for 12 hrs)

2. Hospital disinfectant of premises / OTs

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Acids:-Acids:-• BORIC ACID:-

• Bacteriostatic & Weak antiseptics ,• Non irritating • USES:-

• Irritating eyes (4%), • Mouth washes• Boroglycerin paint (30%)- stomatitis ,Glossitis 2.CUTS AND ABRASION (10%), 3.PRICKLY HEAT POWDERS,EAR

DROPS,IRRIGATING BLADDER.

• ADRs:- vomiting ,Abdominal pain Diarrhoea, visual & kidney damage

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• ACETIC ACIDACETIC ACID:- :- Oldest antiseptic,

BACTERICIDAL – FOR BURN BACTERICIDAL – FOR BURN DRESSING(>5%),DRESSING(>5%),

effective against Pseudomonaseffective against Pseudomonas..

• Salicylic acid- Salicylic acid- Bacteriostatic, Keratolytic (Bacteriostatic, Keratolytic (>25%), 25%), Fungicidal (3%- Whitfield Oint.)Fungicidal (3%- Whitfield Oint.)

• Benzoic acid- Benzoic acid- Fungistatic (6%- Whitfield Oint.)Fungistatic (6%- Whitfield Oint.)

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METALLIC SALTS:-

Mercury compounds:-

• Bacterioststics & Poor antiseptics

• Low TI

• INACTIVATES SH-ENZYMES.

• 1.AMMONIUM MERCURY:

• 5-10% ointments, dermatophytosis

• Anal purities

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• 2.PHENYL MERCURIC NITRATE2.PHENYL MERCURIC NITRATE::

USES: IN TINEA REMEDIES,ANORECTAL PREPARATIONS, OTIC, OCULAR PREPARATIONS & PRESERVATIVES.

MERBROMIN (Mercurochrome):

• BRIGHT RED, ORGANIC MERCURIAL.

• NON-IRRITATING & LESS TOXIC.• USES: 1-2% FOR EYES AND SKIN

antiseptic.

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SILVER COMOUNDSSILVER COMOUNDS::• ASTRINGENT & CAUSTIC.• REACT WITH -SH,-COOH,-PO4,-NH2 PROTEINS.• SILVER NITRATE (slow Ag release)SILVER NITRATE (slow Ag release)• RAPIDILY KILLS MICROBES.• USES: Opthalmia Neonatarum (1% soln.) SOLN.,

APTHOUS ULCER• Demerits: black discoloration of tissues

SILVER SULFADIAZINE:• No black discoloration.• USES: AS OINTMENT IN BURNS / effective in

Pseudomonas inf..40

ZINC SALTSZINC SALTS::• ASTRINGENT & MILD ANTISEPTICS.

• 1.ZINC SULFATE: WATER SOLUBLE.• USES: EYE & EAR DROPS, Mouth wash,

EYE WASH, FOR ACNE AND IMPETIGO, Lotiocalamine (Zno + Calamine), Anti Perspirants.

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DYES:DYES:

• Complex organic substances derived from coal tar

• Gentian violet (crystal violet):

• Rosaniline dye.

• Active against staphylococci,gram +ve bacteria, fungi.

• Uses: alcoholic soln (0.5%) for furunculosis, bed sores, chronic ulcers,infective eczema, thrush, ringworm.

• Demerits- poor efficacy against Gm-ve & in the presence of pus, blue stain on skin

Briliant green :-rosaniline dye.

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• Acridine Dyes: Acriflavin and Proflavin:

• Orange-yellow acridine dyes

• Active against gram + ve bacteria &gonococci.

• Sensitive to light & lose efficacy

• Effective in alk. pH

• Non irritant.

• Uses: chronic ulcers,wounds, burn dressings, Triple dye lotion-gentian violet 0.25%+briliant green 0.25%+ acriflavin 0.1% for burns. Dressing in umbilical stump in neonates.

• Demerits- to be stored in amber coloured bottles

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FURAN DERIVATIVES:FURAN DERIVATIVES:

• Nitrofurozone:• Cidal for gram +ve & gram –ve,aerobic

&anaerobic bacteria.

• Inhibits enzymes for carbohydrates metabolism.

• Use- Efficacious in burns,skin grafting.

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Chronic Toxicity- Skeletal Fluorosis

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