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Antiseptics (from Greek ἀντί: anti, '"against" + σηπτικός: sēptikos, "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antiseptics are generally distinguished from antibiotics by the latter's ability to be transported through the lymphatic system to destroy bacteria within the body, and from disinfectants, which destroy microorganisms found on non-living objects.
Some antiseptics are true germicides, capable of destroying microbes (bacteriocidal), while others are bacteriostatic and only prevent or inhibit their growth.
Antibacterials are antiseptics that have the proven ability to act against bacteria. Microbicides which destroy virus particles are called viricides or antivirals.
Usage in surgery
The widespread introduction of antiseptic surgical methods followed the publishing of the paper Antiseptic Principle of the Practice of Surgery in 1867 by Joseph Lister, inspired by Louis Pasteur's germ theory of putrefaction. In this paper, Lister advocated the use of carbolic acid (phenol) as a method of ensuring that any germs present were killed. Some of this work was anticipated by:
Every antiseptic, however good, is more or less toxic and irritating to a wounded surface; as a result, in surgery, the antiseptic method has been replaced by aseptic method, which is preventative in nature and relies on keeping free from the invasion of bacteria rather than destroying them when present.
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For the growth of bacteria, there must be a food supply, moisture, oxygen (if the bacteria is an obligate aerobe), and a certain minimum temperature (see bacteriology). These conditions have been studied and dealt with in food preservation and the ancient practice of embalming the dead, which is the earliest known systematic use of antiseptics.
In early inquiries before there was an understanding of microbes, much emphasis was given to the prevention of putrefaction, and procedures were carried out to determine the amount of agent that was to be added to a given solution in order to prevent the development of pus and putrefaction; however, due to a lack of a developed understanding of germ theory this method was inaccurate and, today, an antiseptic is judged by its effect on pure cultures of a defined microbe and/or their vegetative and spore forms. The standardization of antiseptics has been implemented in many instances, and a water solution of phenol of a certain fixed strength is now used as the standard to which other antiseptics are compared.
Some common antiseptics
A bottle of ethanol (95%) - an antiseptic
- Boric acid
- Used in suppositories to treat yeast infections of the vagina, in eyewashes, and as an antiviral to shorten the duration of cold sore attacks. Put into creams for burns. Also common in trace amounts in eye contact solution.
- Chlorhexidine Gluconate
- A biguanidine derivative, used in concentrations of 0.5–4.0% alone or in lower concentrations in combination with other compounds, such as alcohols. Used as a skin antiseptic and to treat inflammation of the gums (gingivitis). The microbicidal action is somewhat slow, but remanent. It is a cationic surfactant, similar to Quats.
- Hydrogen peroxide
- Used as a 6% (20 Vols) solution to clean and deodorize wounds and ulcers. More common 3% solutions of hydrogen peroxide have been used in household first aid for scrapes, etc. However, even this less potent form is no longer recommended for typical wound care as the strong oxidization causes scar formation and increases healing time. Gentle washing with mild soap and water or rinsing a scrape with sterile saline is a better practice.
- Usually used in an alcoholic solution (called tincture of iodine) or as Lugol's iodine solution as a pre- and post-operative antiseptic. No longer recommended to disinfect minor wounds because it induces scar tissue formation and increases healing time. Gentle washing with mild soap and water or rinsing a scrape with sterile saline is a comparatively better practice. Novel iodine antiseptics containing povidone-iodine (an iodophor, complex of povidone, a water-soluble polymer, with triiodide anions I3-, containing about 10% of active iodine) are far better tolerated, don't negatively affect wound healing, and leave a deposit of active iodine, thereby creating the so-called "remnant," or persistent, effect. The great advantage of iodine antiseptics is their wide scope of antimicrobial activity, killing all principal pathogens and, given enough time, even spores, which are considered to be the most difficult form of microorganisms to be inactivated by disinfectants and antiseptics.
- Not recognized as safe and effective by the U.S. Food and Drug Administration (FDA) due to concerns about its mercury content. Other obsolete organomercury antiseptics include bis-(phenylmercuric) monohydrogenborate (Famosept).
- Octenidine dihydrochloride
- A cationic surfactant and bis-(dihydropyridinyl)-decane derivative, used in concentrations of 0.1–2.0%. It is similar in its action to the Quats, but is of somewhat broader spectrum of activity. Octenidine is currently increasingly used in continental Europe as a QAC's and chlorhexidine (with respect to its slow action and concerns about the carcinogenic impurity 4-chloroaniline) substitute in water- or alcohol-based skin, mucosa and wound antiseptic. In aqueous formulations, it is often potentiated with addition of 2-phenoxyethanol.
- Phenol (carbolic acid) compounds
- Phenol is germicidal in strong solution, inhibitory in weaker ones. Used as a "scrub" for pre-operative hand cleansing. Used in the form of a powder as an antiseptic baby powder, where it is dusted onto the navel as it heals. Also used in mouthwashes and throat lozenges, where it has a painkilling effect as well as an antiseptic one. Example: TCP. Other phenolic antiseptics include historically important, but today rarely used (sometimes in dental surgery) thymol, today obsolete hexachlorophene, still used triclosan and sodium 3,5-dibromo-4-hydroxybenzenesulfonate (Dibromol).
- Polyhexanide (polyhexamethylene biguanide, PHMB)
- Antimicrobial compound suitable for clinical use in critically colonized or infected acute and chronic wounds. The physicochemical action on the bacterial envelope prevents or impedes the development of resistant bacterial strains.
- See also Antibiotic resistance, Multiple drug resistance
By continued exposure to significant levels of antiseptics or antibiotics, bacteria can evolve to the point where they are no longer harmed by these compounds.
Different antiseptics differ in how they cause bacteria to evolve, which leads to genetic defenses against particular compounds. It can also be dose dependent; resistance can occur at low doses but not at high; and resistance to one compound can sometimes increase resistance to others.
- ^ ἀντί, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
- ^ σηπτικός, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
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- This article incorporates text from a publication now in the public domain: Chisholm, Hugh, ed. (1911). "Antiseptics". Encyclopædia Britannica (11th ed.). Cambridge University Press.