[Prevention of respiratory infection in patients following surgical intervention].

The objective of the present study was to estimate the efficacy of therapy with hexetedine for the prevention of the respiratory infection in the patients undergoing surgical intervention. The study included 64 patients (28 adults and 36 children) ranging in the age from 3 to 55 years who were examined before and after surgery (radiosurgical tonsillectomy and radiosurgical uvulopalatoplasty). Complete clinical examination was supplemented by a microbiological study of cultivated mucosal swab samples obtained from the pharynx before and after the treatment. 41 patients of the study group received hexetedine (hexoral) for the 4 days preceding the operation and during 3 days of the postoperative period. It was shown that the patients treated with hexetedine both in the pre- and postoperative periods experienced a substantial decrease in microbial infestation of pharyngeal mucosa and accelerated elimination of the inflammatory process. Moreover, the general therapeutic effect on day 5 after surgery was more pronounced in the hexetedine-treated patients compared with controls.

[Efficacy of an antiseptic dialysis of purulent wounds in the dentofacial region with hyvalix].

The article presents data proving the possibility of using the solutions of "Hyvalix" medication for an antiseptic preparation of septic cavities after lancing of abscesses and phlegmons of dentofacial region. It was shown the efficacy of "Hyvalix" medication in comparison with traditional solutions of antiseptic means.

In vitro antifungal properties of mouthrinses containing antimicrobial agents.

The purpose of this study was to investigate the in vitro antifungal properties of seven commercial mouthrinses containing antimicrobial agents. These included cetylpyridinium chloride (CPC), chlorhexidine digluconate (CHX), hexetidine (HEX), sanguinarine (SNG), and triclosan (TRN). The minimum fungicidal concentration (MFC) against six species of yeasts was determined by a broth macrodilution method. The kill-time of mouthrinses at half the concentration of the commercial formulations was also determined. MFCs were achieved with each mouthrinse, except the SNG-containing mouthrinse, against all the organisms being tested. However, the CPC-containing mouthrinse appeared more active than the other products (P < 0.001). There were no significant differences in MFC values among CHX mouthrinse products, once adjusted for initial concentration differences (P = 0.1). Kill-times of mouthrinses containing either CHX or CPC were less than or equal to 180 seconds with all the species of yeasts, and no significant differences were found among these products (P = 0.18). On the other hand, mouthrinses containing either TRN or HEX did not show a lethal effect on Candida albicans, Candida parapsilosis, or Candida guilliermondii. No kill-times were achieved with the SNG-containing mouthrinse. These results suggest that mouthrinses containing antimicrobial agents might represent an appropriate alternative to conventional antifungal drugs in the management of oral candidiasis. However, the effectiveness of antimicrobial mouthrinses as antifungal agents needs to be evaluated in further clinical trials.

A comparative study in vivo of the therapeutic effect of triclosan, hexetidine and chitosan.

The present clinical study was performed to comparatively assess the therapeutic effect of Low and High Molecular Weight Chitosan (LMWCh and HMWCh), hexetidine, triclosan. Plaque index, saliva buffering capacity and bacteriological controls for S. mutans and lactobacilli, were performed. The plaque and bacterial indices revealed statistically significant differences between groups. Buffering capacity was similar using, hexetidine, and triclosan, whereas it was maximum in 100% of the patients in the LMWCh and HMWCh groups. Only 0.5% HMWCh induced low activity of S. mutans in 100% of the patients and caused complete inhibition of lactobacilli growth. No changes were observed in the profile of salivary proteins. The present clinical study confirms the therapeutic efficacy of the chitosan as a bacteriostatic agent.

Antimicrobial topical agents used in the vagina.

Vaginally applied antimicrobial agents are widely used in the vagina in women with lower genital tract infections. An 'antimicrobial' is a general term that refers to a group of drugs that are effective against bacteria, fungi, viruses and protozoa. Topical treatments can be prescribed for a wide variety of vaginal infections. Many bacterial infections, such as bacterial vaginosis, desquamative inflammatory vaginitis or, as some European authors call it, aerobic vaginitis as well as infection with Staphylococcus aureus or group A streptococci, may be treated in this way. Candida vulvovaginitis is a fungal infection that is very amenable to topical treatment. The most common viral infections which can be treated with topical medications are condylomata acuminata and herpes simplex. The most often encountered protozoal vaginitis, which is caused by Trichomonas vaginalis, may be susceptible to topical medications, although this infection is treated systemically. This chapter covers the wide variety of commonly used topical antimicrobial agents for these diseases and focuses on the individual therapeutic agents and their clinical efficacy. In addition, potential difficulties that can occur in practice, as well as the usage of these medications in the special setting of pregnancy, are described in this chapter.

Fluconazole and/or hexetidine for management of oral candidiasis associated with denture-induced stomatitis.

OBJECTIVE: The aim of the present study was to compare the influence of fluconazole capsules and/or hexetidine mouthrinses for the management of oral candidiasis associated with denture stomatitis. DESIGN RELEVANT: Sixty-one patients (ages 43-76 years, mean: 61) admitted to the Department of Oral Surgery and Medicine and diagnosed as suffering from oral candidiasis associated with denture stomatitis by microbiological examination were involved. MATERIALS AND METHODS: Patients in group 1 (n = 21) were given only fluconazole capsules (Zolax 50 mg once a day), those in group 2 (n = 18) were given only hexetidine mouthrinses (Heksoral 0.1%, twice daily), whereas those in group 3 (n = 22) were given both fluconazole capsules and hexetidine mouthrinses for 14 days. The yeast colonies of the saliva samples were counted and calculated as the number of colony forming units per milliliter. The presence of yeasts in the lesion and denture samples were evaluated as present/absent according to their growth on cultures. Candida albicans was identified by means of germ tube analysis. RESULTS: Patients in groups 1, 2 and 3 had a statistically significant decrease in the amount of C. albicans in saliva, lesions and dentures after treatment, when compared with pretreatment results (P < 0.05). Candida albicans counts in saliva, lesion and denture after treatment detected no statistically significant difference when the three groups were compared. CONCLUSION: Of the three study groups, group 2, where hexetidine was the only medication prescribed, was found to be superior on account of fewer potential complications. We conclude that dentists should employ a more conservative intervention with oral mouthrinses rather than risk adverse effects and complications of systemic drugs for the management of oral candidiasis.

[Chemical control of plaque: comparative review]. / Contrôle chimique de la plaque: revue comparative.

Plaque control can be achieved by mechanical means. Since plaque removal can be laborious and difficult, chemical agents became important adjuncts to traditional oral hygiene procedures. Chlorhexidine is one of the synthetic antiseptics that has a unique antiplaque effect and 0.2% chlorhexidine can achieve a practically complete plaque control. It has one negative effect namely an extrinsic brown-yellow staining. Listerine has proven its ability to reduce plaque and gingivitis in a moderate way. Hexetidine has a greater antiplaque effect in combination with zinc and can be compared with a 0.1% chlorhexidine. Povidone-iodine can not be used to keep plaque at low levels. Sanguinarine can reduce plaque accumulation when the toothpaste and mouthrinse are used together. H2O2 is an antiplaque agent but has some negative effects such as ulcerations... One can conclude that the use of a chemical agent cannot replace a good mechanical plaque control but is rather an adjunct to oral hygiene under certain conditions.

Effect of a combination of copper and hexetidine on the acidogenicity and copper accumulation in dental plaque in vivo.

A double-blind crossover study on 4 adult volunteers was performed to evaluate the effect of hexetidine on Cu2+ accumulation in dental plaque as well as a possible enhanced effect of copper on inhibition of acid production in the presence of hexetidine. The experimental period was 5 days. No oral hygiene was allowed, and sucrose-containing chewing gum was used to enhance plaque formation during the test period. In order to evaluate the effect on pH, the test persons rinsed with a 15% glucose (w/v) solution on the 5th experimental day. Plaque pH values recorded before and 5 min after the rinse served as control values. One hour later the test persons rinsed with 10 ml of the test solutions for 1 min. Glucose rinses with pH measurements 5 min after the rinse were carried out 0, 3, and 7 h after the test agents were used. The combination of 1.0 mM copper and 2.0 mM hexetidine gave a significant (p less than 0.05) inhibition of acid production at all times compared both to the controls and to each of the test agents separately. Plaque samples were collected with a toothpick immediately before a 1-min rinse with 10 ml of the test solutions. Subsequent plaque samples were taken 5 min and 3 and 8 h after a rinse from corresponding tooth surfaces. Dry weight was estimated, the plaque bacteria digested by HNO3, and the amount of Cu2+ determined by atomic absorption.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of a combination of copper and hexetidine on plaque formation and the amount of copper retained by dental plaque bacteria.

Zn++ in combination with hexetidine exerts a synergistic plaque inhibition. Studies in our laboratory on the mechanism of this effect suggested that Cu++ and hexetidine may have a similar combination effect. This hypothesis was tested in vivo on a human test panel in a double-blind crossover study. The amount of Cu++ retained by plaque bacteria in vitro was also evaluated. Seven volunteers rinsed with the solutions for 1 min twice daily for 5 days. The test solutions were H2O, 1.0 mM CuSO4, 2.0 mM hexetidine, and the last two in combination. During the test period no oral hygiene was allowed, and sucrose-containing chewing gum was used to enhance plaque formation. The plaque index scores after rinsing with the combination were significantly (p less than 0.05) lower than those of the other solutions. The effect of hexetidine on Cu++ retention in plaque bacteria was evaluated in plaque samples (n = 3) grown anaerobically overnight in PPLO medium. The bacteria were washed five times, digested in concentrated HNO3, and Cu++ determined by atomic absorption. The presence of hexetidine resulted in a significantly greater amount of Cu++ retained by bacteria at all CuSO4 concentrations. It is suggested that the nonpolar nature of the hexetidine molecule enables Cu++ bound to hexetidine to pass into the bacterial cell. Within the cell, Cu++ can interfere with bacterial metabolism, giving a reduction in plaque growth.

Plaque inhibition by hexetidine and zinc.

Rinsing experiments with mouthwashes containing zinc ions, hexetidine and a combination of hexetidine and zinc ions were performed with a group of 10 volunteers. The amount of plaque was assessed after rinsing with the test solutions for 4 days during which mechanical toothcleaning was discontinued. Significantly improved inhibition was observed by the combination of hexetidine and zinc ions compared with the two agents used separately. In vitro bacteriological tests showed that hexetidine and zinc ions had a synergistic inhibitory effect on the growth of Streptococcus mutans.

Synergistic antibacterial effects of copper and hexetidine against Streptococcus sobrinus and Streptococcus sanguis.

The aim of this study was to determine whether a combination of copper and hexetidine had a synergistic antibacterial effect against Streptococcus sobrinus OMZ 176 and S. sanguis 10556. Concentration ranges of the test agents alone and in combination were prepared by serial dilutions in microtiter trays with brain-heart infusion (BHI) broth as the bacterial growth medium. After incubation at 37 degrees C for 24 h, the minimum inhibitory concentration (MIC), corresponding to the lowest concentration showing no visible growth, was determined. Evaluated by the fractional inhibitory concentration index, a strong synergistic effect ranging from 0.39 to 0.40 was observed. A similar effect was also demonstrated by growth curves, which were constructed on the basis of growth in BHI broth with addition of MIC/4 of each agent alone or MIC/8 of each agent in combination. A probable explanation for these findings is that the surface-active hexetidine molecule alters the bacterial cell surfaces and thereby enables an increased amount of copper to be transported into the cell.

The effect of hexetidine spray on dental plaque following periodontal surgery.

The aim of the present study was to determine the effects of a 0.2% hexetidine spray, used as a supplement to regular oral hygiene measures, on dental plaque and gingival condition following periodontal surgery. This study was carried out on 38 patients who required 2 episodes of periodontal surgery. Examinations regarding dental plaque were performed at 0, 7, 14, 21 and 28 days, while the condition of the gingiva were examined at 0 and 28 days. Dental plaque was assessed by the Turesky modification of Quigley-Hein index; the gingival condition was evaluated using the gingival index of Löe-Silness and the papilla bleeding index. In a double-blind cross-over study of 28 days duration, significant reduction in plaque accumulation and an improvement in wound healing were demonstrated for the test spray compared to the placebo.

Comparison of the in vivo and in vitro antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, cetyl pyridinium chloride and hexetidine. Relevance to mode of action.

A study was carried out to compare the antibacterial properties of four cationic antiseptics, three of which are available as commercial mouthrinse preparations. Minimum inhibitory concentrations for alexidine, cetyl pyridinium chloride, chlorhexidine gluconate and hexetidine against a range of standard test organisms, were determined by tube dilution. Similar values for Oxford staphylococcus were then obtained in Dubos medium to which protein as yeast, or food extract, or serum was added in doubling dilutions to 16%. Salivary bacterial counts after a single rinse with the antiseptics or water throughout the day were measured in 10 subjects together with the duration of any residual antiseptic activity in the saliva. All antiseptics were effective at low concentrations against the organisms tested but the minimum inhibitory concentration values for hexetidine were the highest. Food extract and serum markedly increased the minimum inhibitory concentration values of all antiseptics, although alexidine and hexetidine were the least affected in percentage terms. The activity of a 1% povidone iodine preparation, used for comparison, was almost completely vitiated. An immediate significant fall in salivary bacterial counts was produced by the cationic antiseptics. Return to pre-rinse levels was seen for hexetidine after 90 min, cetyl pyridinium chloride after 3 hours, alexidine after 5 hours and chlorhexidine gluconate after 7 hours. Residual salivary antibacterial activity remained to 90 min for cetyl pyridinium chloride, to 3 hours for hexetidine and alexidine and to 5 hours for chlorhexidine gluconate. The antibacterial properties measured, in particular the duration of effect in vivo, may be relevant to the anti-plaque activity of cationic antiseptics.

The effect on early plaque formation, gingivitis and salivary bacterial counts of mouthwashes containing hexetidine/zinc, aminefluoride/tin or chlorhexidine.

This study was designed to investigate the effectiveness of mouthwashes containing hexetidine/zinc (HZA) or tin (ASF) in inhibiting plaque formation and gingivitis in humans. 24 dental students and assistants participated in the study (latin square design) with 7-day test periods. They rinsed twice daily for 1 min with one of the following formulations: HZA = 750 ppm hexetidine/750 ppm zinc acetate, ASF = 100 ppm aminefluorid/310 ppm stannous fluoride, CHX = 0.1% chlorhexidine and M = negative control. Plaque accumulation was determined planimetrically and gravimetrically. Gingivitis was evaluated with the papillary bleeding index. Total colony forming units and S. mutans counts were estimated from saliva samples. The results showed that HZA and CHX almost completely inhibited plaque accumulation and gingivitis. ASF was less effective than HZA and CHX but still reduced plaque significantly compared to the negative control. Furthermore, CHX reduced salivary S. mutans counts.

[The advantage of preventive vaginal antisepsis with hexetidine in obstetrics and gynecology]. / Nutzen der prophylaktischen Vaginalantiseptik mit Hexetidin in Geburtshilfe und Gynäkologie.

In five studies, the advantage of repeated vaginal prophylaxis by a new preparation of hexetidine vaginal suppositories (10 mg) was investigated prospectively, randomised and method-controlled (n = 2 x 50). After a five-day application, the hexetidine group achieved bacterial reductions of five log CFU/ml in the vagina and nearly three log CFU/ml in the cervix uteri, whilst no reduction was found in the controls at any time (p less than 0.01). The reduction of individual bacterial species was investigated in 224 pregnant and also gynaecological patients. In cases of impending preterm childbirth, a five-day application of 20 mg hexetidine/day could reduce all bacteria sufficiently with the exception of lactobacilli; especially beta Streptococci were reduced. The same was achieved by a three-day application of 10 mg hexetidine/day pre-operatively. A long-term study in 11,724 deliveries showed, that neonatal infectious mortality and morbidity after 36 gestational weeks could be reduced significantly by hexetidine. The new hexetidine preparation appeared to be efficient in vaginal antisepsis, especially in pregnancy. A favourable lactobacilli-selective effect was demonstrated. Since the importance of lactobacilli in vaginal ecology is known, hexetidine prophylaxis must be considered as advantageous in Obstetrics and Gynecology. From a practical and economic point of view, the application of hexetidine as vaginal suppositories appears favourable compared to antiseptic solutions.

Effects of subinhibitory concentrations of chemical agents on hydrophobicity and in vitro adherence of Streptococcus mutans and Streptococcus sanguis.

The aim of this investigation was to determine whether sublethal concentrations of chlorhexidine (Cx), hexetidine (Hx), cetylpyridinium chloride (Cc), sodium dodecyl sulfate (SDS), sanguinarine (Sg), sodium fluoride (NaF), and ammonium fluoride (NH4F) could affect hydrophobicity and adhesion of Streptococcus sanguis and Streptococcus mutans to saliva-coated hydroxyapatite (S-HA). Determination of the minimum inhibitory concentrations (MICs) showed that both species were susceptible to all agents tested. Growth in the presence of sub-MIC concentrations of Cx, SDS, Cc, NaF, or NH4F did not change significantly the hydrophobicity of S. sanguis cells when compared to the control which lacked any agent. However, growth in the presence of Hx or Sg resulted in a significant reduction in their hydrophobicity. Sub-MIC levels of SDS or Sg in the growth medium resulted in S. mutans cells with increased affinity for hexadecane compared with the control. The adherence of S. sanguis was changed significantly only by Hx or Sg, resulting in less cells adhering to S-HA. However, S. mutans cells previously incubated with NaF, NH4F, or Sg showed a higher adherence to S-HA than the control. The mechanisms of interference with adherence are at present not completely understood. Thus, antimicrobial agents at sub-MIC concentrations can interfere selectively with hydrophobicity and/or adhesion of oral streptococci.