Usual Adult Dose for Gingivitis

Usual dose: 15 mL (approximately 0.5 fluid ounces) swished in the mouth undiluted for 30 seconds and spit out 2 times a day

Comments:

• To decrease medicinal taste, patients should not rinse with water immediately after use.
• The mouthwash should be used after meals (e.g., after breakfast and dinner).

Use:

• Use between dental visits to treat gingivitis (characterized by redness and swelling of the gingivae and gingival bleeding upon probing)

Usual Adult Dose for Mucositis

Usual dose: 15 mL (approximately 0.5 fluid ounces) swished in the mouth undiluted for 30 seconds and spit out 2 times a day

Comments:

• To decrease medicinal taste, patients should not rinse with water immediately after use.
• The mouthwash should be used after meals (e.g., after breakfast and dinner).

Use:

• Use between dental visits to treat gingivitis (characterized by redness and swelling of the gingivae and gingival bleeding upon probing)

Usual Adult Dose for Periodontitis

Usual dose: 2.5 mg (1 periodontal chip) inserted into a periodontal pocket with probing pocket depth (PD) of 5 mm or more every 3 months
Maximum dose: Up to 8 periodontal chips/visit

Comments:

• The area should be isolated and dried before administration.
• Forceps should be used to insert the chip into the maximum depth of the periodontal pocket.
• The chip biodegrades completely and does not require removal.

Uses:

• Adjunct to scaling and root planing procedures for reduction of pocket depth in patients with periodontitis
• Part of a periodontal maintenance program, including good oral hygiene and scaling and root planing

Usual Adult Dose for Skin Disinfection, Preoperative

Chlorhexidine Gluconate 0.5% Topical Solution (Towelette)

• Hands should be rubbed vigorously with the towelette for approximately 15 seconds, with particular attention to the nails and interdigital spaces. Water and further toweling are not required.

Use: As a hand antiseptic to reduce bacteria that could cause disease

Chlorhexidine Gluconate 0.75% Topical Solution/Hand Wash:

• Wet hands with water, then apply approximately 5 mL into cupped hands and wash vigorously for 30 seconds. Personnel should wash and dry hands thoroughly.

Use: As a healthcare personnel hand wash to reduce bacteria that could cause disease

Chlorhexidine Gluconate 2% Topical Solution:

• SURGICAL HAND SCRUB: Remove jewelry, wet hands and forearms with water and dispense 5 grams into hands. Hands and forearms should be washed/scrubbed for 3 minutes, then rinsed thoroughly with water; hands and forearms should be washed for an additional 3 minutes with 5 grams, rinsed with water, and thoroughly dried.
• HEALTHCARE PERSONNEL HAND WASH: Hands should be wet with water, then 5 grams of this drug should be applied into the hands and washed vigorously for 30 seconds. Hands should be rinsed and dried thoroughly.
• SKIN PREPARATION: The preparation should be applied with gentle back-and-forth strokes for approximately 30 seconds (dry surgical sites) to 2 minutes (moist surgical sites) and allowed to dry completely (e.g., at least 3 minutes with hairless sites, and up to 1 hour in hair).
• SKIN WOUND/GENERAL SKIN CLEANSER: The affected area should be thoroughly rinsed with water, then the minimum amount of product to cover the area should be applied and washed gently. The affected area should be rinsed thoroughly with water.

Uses:

• As a surgical hand scrub to significantly reduce the number of microorganisms on the hands and forearms prior to surgery or patient care
• As a healthcare personnel hand wash to help reduce bacteria that may cause disease
• As a skin wound/general skin cleanser to reduce bacteria on the skin

Chlorhexidine Gluconate 4% Topical Solution

• SURGICAL HAND SCRUB: Wet hands and forearms with water and dispense 5 grams OR 1 sponge into hands, paying particular attention to the nails, cuticles, and interdigital spaces. Hands and forearms should be washed/scrubbed for 3 minutes, then rinsed thoroughly with water; hands and forearms should be washed for an additional 3 minutes with 5 grams and rinsed with water, and the treated areas should be dried thoroughly.
• HEALTHCARE PERSONNEL HAND WASH: Hands should be wet with water, then 5 grams of this drug should be applied into the hands and washed vigorously for 15 seconds. Hands should be rinsed and dried thoroughly.
• PATIENT PREOPERATIVE SKIN PREPARATION: The solution should be applied liberally to the surgical side and swabbed for at least 2 minutes; the area should be dried with a sterile towel. The site should then be swabbed for 2 minutes and dried with a sterile towel.
• SKIN WOUND AND GENERAL SKIN CLEANSING: The affected area should be thoroughly rinsed with water, then the minimum amount of product to cover the area should be applied and washed gently. The affected area should be rinsed thoroughly with water.

Comments:

• Nails, cuticles, and interdigital spaces may be washed with a nail brush/pick.
• If included, the sponge should be used to create a lather, and then used to apply the solution to the hands and forearms.

Uses:

• As a surgical hand scrub to significantly reduce the number of microorganisms on the hands and forearms before surgery or patient care
• As a healthcare professional hand wash to reduce bacteria that may cause disease
• As a patient preoperative skin preparation for the preparation of the patient's skin prior to surgery
• As a skin wound and general skin cleanser

Chlorhexidine Gluconate 92 mg Topical Dressing

• The patch should be placed on cleansed skin surrounding a percutaneous device, with the white foam side facing the skin. Percutaneous devices should be placed along the slit portion of the patch, and then the edges of the patch should be pushed together until they touch.
• Duration of treatment: Up to 7 days

Comments:

• The patch may turn yellow during use, but efficacy of the patch is unaffected.
• Patients with highly exuding wounds may require more frequent patch changes.

Uses:

• Absorb exudate and cover a wound caused by vascular/non-vascular percutaneous medical devices (e.g., IV catheters, central venous lines, arterial catheters, dialysis catheters, peripherally inserted coronary catheters, mid-line catheters, drains, chest tubes, externally placed orthopedic pins, epidural catheters)
• Reduce local infections, catheter-related blood stream infections (CRBSI) and skin colonization of microorganisms related to CRBSI in patients with central venous/arterial catheters

Usual Pediatric Dose for Skin Disinfection, Preoperative

2 MONTHS AND OLDER:
Chlorhexidine Gluconate 0.5% Topical Solution (Towelette)

• Hands should be rubbed vigorously with the towelette for approximately 15 seconds, with particular attention to the nails and interdigital spaces. Water and further toweling are not required.

Use: As a hand antiseptic to reduce bacteria that could cause disease

Chlorhexidine Gluconate 0.75% Topical Solution/Hand Wash:

• Wet hands with water, then apply approximately 5 mL into cupped hands and wash vigorously for 30 seconds. Patients should wash and dry hands thoroughly.

Use: As a healthcare personnel hand wash to reduce bacteria that could cause disease

Chlorhexidine Gluconate 2% Topical Solution:

• SURGICAL HAND SCRUB: Remove jewelry, wet hands and forearms with water and dispense 5 grams into hands. Hands and forearms should be washed/scrubbed for 3 minutes, then rinsed thoroughly with water; hands and forearms should be washed for an additional 3 minutes with 5 grams, rinsed with water, and thoroughly dried.
• HEALTHCARE PERSONNEL HAND WASH: Hands should be wet with water, then 5 grams of this drug should be applied into the hands and washed vigorously for 30 seconds. Hands should be rinsed and dried thoroughly.
• SKIN PREPARATION: The preparation should be applied with gentle back-and-forth strokes for approximately 30 seconds (dry surgical sites) to 2 minutes (moist surgical sites) and allowed to dry completely (e.g., at least 3 minutes with hairless sites, and up to 1 hour in hair).
• SKIN WOUND/GENERAL SKIN CLEANSER: The affected area should be thoroughly rinsed with water, and then the minimum amount of product to cover the area should be applied and washed gently. The affected area should be rinsed thoroughly with water.

Comments:

• When used for skin preparation, one applicator may cover an area up to 130 cm2.
• The skin preparation solution should not be allowed to pool.

Uses:

• As a surgical hand scrub to significantly reduce the number of microorganisms on the hands and forearms prior to surgery or patient care
• As a healthcare personnel hand wash to help reduce bacteria that may cause disease
• As a skin wound/general skin cleanser to reduce bacteria on the skin
• Preparation of the patient's skin before surgery to reduce bacteria that could cause skin infection.

Chlorhexidine Gluconate 4% Topical Solution

• SURGICAL HAND SCRUB: Wet hands and forearms with water and dispense 5 grams OR 1 sponge into hands, paying particular attention to the nails, cuticles, and interdigital spaces. Hands and forearms should be washed/scrubbed for 3 minutes, and then rinsed thoroughly with water; hands and forearms should be washed for an additional 3 minutes with 5 grams of solution, rinsed with water, and the treated areas should be dried thoroughly.
• HEALTHCARE PERSONNEL HAND WASH: Hands should be wet with water, and then 5 grams of this drug should be applied into the hands and washed vigorously for 15 seconds. Hands should be rinsed and dried thoroughly.
• PATIENT PREOPERATIVE SKIN PREPARATION: The solution should be applied liberally to the surgical side and swabbed for at least 2 minutes; the area should be dried with a sterile towel. The site should then be swabbed for 2 minutes and dried with a sterile towel.
• SKIN WOUND AND GENERAL SKIN CLEANSING: The affected area should be thoroughly rinsed with water, then the minimum amount of product to cover the area should be applied and washed gently. The affected area should be rinsed thoroughly with water.

Comments:

• Nails, cuticles, and interdigital spaces may be washed with a nail brush/pick.
• If included, the sponge should be used to create a lather, and then used to apply topical solution to the hands and forearms.

Uses:

• As a surgical hand scrub to significantly reduce the number of microorganisms on the hands and forearms before surgery or patient care
• As a healthcare professional hand wash to reduce bacteria that may cause disease
• As a patient preoperative skin preparation for the preparation of the patient's skin prior to surgery
• As a skin wound and general skin cleanser

16 YEARS AND OLDER:
Chlorhexidine Gluconate 92 mg Topical Dressing

• The patch should be placed on cleansed skin surrounding a percutaneous device, with the white foam side facing the skin. Percutaneous devices should be placed along the slit portion of the patch, and then the edges of the patch should be pushed together until they touch.
• Duration of treatment: Up to 7 days

Comments:

• The patch may turn yellow during use, but efficacy of the patch is unaffected.
• Patients with highly exuding wounds may require more frequent patch changes.

Uses:

• Absorb exudate and cover a wound caused by vascular/non-vascular percutaneous medical devices (e.g., IV catheters, central venous lines, arterial catheters, dialysis catheters, peripherally inserted coronary catheters, mid-line catheters, drains, chest tubes, externally placed orthopedic pins, epidural catheters)
• Reduce local infections, catheter-related blood stream infections (CRBSI) and skin colonization of microorganisms related to CRBSI in patients with central venous/arterial catheters

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Periodontal Chip:

• Dislodgement within 48 hours of placement: A new chip should be placed.
• Dislodgement more than 48 hours after placement: The chip should not be replaced, but the patient should be reevaluated at 3 months. A new chip should be placed if the pocket depth is not less than 5 mm.
• Dislodgement 7 or more days after insertion: The patient should be considered to have received a full course of treatment.

Precautions

Safety and efficacy have not been established in patients younger than 2 months (topical solution), 16 years (92 mg skin dressings), and 18 years (oral mouthwash). The periodontal chip formulation is not recommended for use in children

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Patients should ensure that oral and irrigation solutions are clear and free of particles before use.
• Topical solutions should not be diluted prior to use.
• Chlorhexidine 92 mg patch formulations should not be applied to infected and/or burned skin, and should not be used to treat existing percutaneous device-related infections.

Storage requirements:

• Irrigation and oral solutions should be protected from light.
• Once the topical solution is opened, any remaining solution should be discarded after 24 hours.

General:

• This drug has not been tested in patients with necrotizing ulcerative gingivitis (ANUG).
• Treatment is effective against many vegetative gram-positive/-negative bacteria, some viruses, and some fungi, but it is ineffective against room temperature bacterial spores. Acid-fast bacteria are inhibited with use, but are not killed.

Patient advice:

• Patients should be told to report any signs/symptoms of allergic or adverse reactions (e.g., skin rash/itching, generalized swelling, breathing difficulties, lightheadedness, rapid heart rate, upset stomach/diarrhea).
• Patients who receive the periodontal chip formulation should immediately contact their dentist if the chip becomes dislodged.