View source for 81. Antiseptics and disinfectants

A disinfectant is a compound which destroys or inhibits the growth of microorganisms on ''non-living objects'', like tables, walls, beds, etc.

An antiseptic is a compound which destroys or inhibits the growth of microorganisms on ''living tissue'', like on the skin or on mucous membranes. They are not meant for systemic use, which separates them from antibiotics.

An ideal antiseptic (or disinfectant) must have the following properties. It must:

* destroy or remove all pathogenic microorganisms
* act at relatively low concentrations
* not destroy or harm the skin, mucous membranes or non-living materials
* not be systemically toxic for humans after absorption
* not have a strong odour
* be stable against air and light
* not stain objects and tissues
* be cheap
* be biologically degradable
* not be inactivated by organic material like blood, pus, etc.

=== Asepsis ===
Asepsis is the state of being free from pathogenic microorganisms. Being aseptic is important in surgical fields to prevent infections. The term is also used to refer to those measures which are used to induce asepsis.

=== Sterilization ===
Sterilization is a technique which completely destroys or removes all microbial life, including spores and prions, from the surface of an object or in a fluid. There are many methods of sterilization, like heating, steaming, radiating and filtration, but the most important for us is the use of chemicals for sterilization.

=== Phenol coefficient ===
The phenol coefficient of an antiseptic (or disinfectant) is a measure of how high its bactericidal activity is. The efficacy of the antiseptic is compared to that of phenol. It’s measured as which concentration of the antiseptic must be applied to have the same bactericidal effects as phenol. For example, if a you need 0,1 mol/L of a new antiseptic to have the same antiseptic effects as 1 mol/L phenol the phenol coefficient of the new antiseptic will be 10.

== Alcohols ==

=== Compounds ===

* Isopropanol
* Ethanol

The compounds are used in relatively high concentrations, 60-70%.

=== Mechanism of action ===
Alcohols denaturate proteins and dissolves lipids.

=== Antimicrobial spectrum ===
Bacteria, enveloped viruses, fungi. Not spores or parasites.

=== Uses ===
Alcohols can be to disinfect skin and mucous membranes and as disinfectants. They’re often used in combination with other antiseptics or disinfectants.

Ethanol dries out skin, but isopropanol doesn’t. Alcohols are inactivated by biological material, so they can’t disinfect surfaces which are stained by biological material.

== Glycols ==

=== Compound ===
Triethylene glycol.

=== Mechanism of action ===
Same as for alcohols (?).

=== Use ===
Aerosolized triethylene glycol is used to sterilize air.

== Aldehydes ==

=== Compounds ===

* Glutaraldehyde
* Formaldehyde

=== Mechanism of action ===
Aldehydes react with amino moieties of proteins, precipitating them.

=== Antimicrobial spectrum ===
Bacteria, viruses, fungi and spores. Aldehydes have the widest antimicrobial spectrum.

=== Use ===
Aldehydes damage tissues, so they can’t be used as antiseptics. Glutaraldehyde is used to sterilize surfaces and equipment. Formaldehyde gas is used to sterilize rooms.

Aldehydes are allergenic. Formaldehyde vapour is carcinogenic and an irritant.

== Phenol and phenol derivatives ==

=== Compounds ===

* Phenol
* Phenol derivatives
** Cresols
** Hexachlorophene

Phenol itself was the first antiseptic agent which was used. It’s toxic if it reaches the system, it is irritating, and it is corrosive. For those reason, phenol itself is not used as an antiseptic.

Hexachlorophene itself was also previously used as a disinfectant and in cosmetics, but it was found to be neurotoxic.

=== Mechanism of action ===
Same as for alcohols (?).

=== Antimicrobial spectrum ===
Cresols are bactericidal and parasiticidal. Hexachlorophenes is mostly only active against Gram-positive bacteria.

=== Uses ===
Disinfection of equipment and surfaces. Amylmetacresol, a type of cresol, is the active ingredient in Strepsils.

Phenol can be used to treat ingrown toenails.

== Biguanides ==

=== Compounds ===
Chlorhexidine is the only important biguanide. It is often dyed yellow.

=== Mechanism of action ===
Chlorhexidine binds to and disrupts cell walls, causing leak of intracellular components.

=== Antimicrobial spectrum ===
Bacteriostatic. Not effective against pseudomonas.

=== Use ===
Chlorhexidine is used for disinfection of the skin and mucous membranes. Chlorhexidine can also be used as a mouthwash. However, it discolours teeth.

Chlorhexidine is often combined with alcohols. It can also be used as a preservative.

== Chlorine and chlorine compounds ==

=== Compounds ===

* Chlorine
* Chlorine compounds
** Sodium hypochlorite

Sodium hypochlorite is the main ingredient of household bleach.

=== Mechanism of action ===
Oxidization and denaturation of DNA, RNA, proteins.

=== Antimicrobial spectrum ===
Bacteria, viruses, fungi, spores. The antimicrobial activity of chlorine and chlorine compounds is pH dependant, but they are active at physiological pH.

=== Use ===
Hypochlorite can be used to disinfect equipment and surfaces.

Chlorine is used to sterilize water.

== Iodine and iodine compounds ==
Iodophors are combinations of iodine and a solubilizing agent.

=== Compounds ===

* Lugol’s iodine
* Iodophors
** Povidone-iodine

Lugol’s iodine is a mix of iodine, potassium iodine and water.

=== Mechanism of action ===
Iodophors halogenate and damage DNA, RNA and proteins.

=== Antimicrobial spectrum ===
Bacteria, fungi, viruses, spores.

=== Use ===
Antisepsis of skin and mucous membranes. Preoperative antisepsis of skin. Lugol’s iodine is also used during Gram staining.

== Oxidizing agents ==

=== Compounds ===

* Hydrogen peroxide
* Benzoyl peroxide
* Ozone
* Peracetic acid

=== Mechanism of action ===
Catalase reacts with the peroxides, releasing free radicals which damage lipids, proteins, DNA, RNA.

=== Antimicrobial spectrum ===
Bacteria, viruses, fungi, spores.

=== Use ===
Hydrogen peroxide has many uses. It can be used as an antiseptic and a disinfectant. In low concentrations it can be used to clean contact lenses. It can also be used as a bleaching agent.

Hydrogen peroxide is inactivated by organic material, so it can’t disinfect surfaces which are stained by biological material. It’s also corrosive.

Benzoyl peroxide is often used in anti-acne creams (Basiron®), as it kills ''Propionibacterium acnes.''

Ozone is used to sterilize air or water.

Peracetic acid is used to sterilize equipment.

== Heavy metals ==

=== Compounds ===

* Inorganic mercury
* Organic mercuries
** Thiomersal
* Silver
* Zinc oxide

=== Mechanism of action ===
Heavy metals are biocidal thanks to the so-called ''oligodynamic effect''. Heavy metals, even in very low concentrations, bind to sulphur and nitrogen atoms in proteins. This precipitates proteins.

=== Antimicrobial spectrum ===
Bacteria.

=== Uses ===
Mercury itself is toxic and not used. Thiomersal is an excellent preservative for vaccines, as it allows the use of more than one dose in each vial. However, the anti-vaccination movement has forced health authorities to stop using thiomersal in vaccines in North America and Europe, despite there not being any evidence that it is harmful. Thiomersal is still used in vaccines in other parts of the world.

Silver can be used as adjuvants in vaccines and antibiotics, increasing their efficacy. It can also be used to coat materials which should be antibacterial.

Zinc oxide is often used in deodorants and sunscreen.

== Quaternary ammonium compounds ==
Quaternary ammonium compounds are cationic detergents, as opposed to regular detergents, which are anionic.

=== Mechanism of action ===
These compounds increase the permeability of plasma membranes and denaturate proteins. The quaternary nitrogen mediates these effects.

Detergents reduce surface tension.

=== Antimicrobial spectrum ===
Gram-positive bacteria and fungi.

=== Use ===
By reducing the surface tension these compounds can increase the effect of other disinfectants and antiseptics. They’re often combined with chlorhexidine. They can be used alone to clean equipment and surfaces.

Cationic detergents are inactivated by soaps (which are anionic detergents) and organic material.

== Urinary antiseptics ==
Unlike normal antiseptics, urinary antiseptics are given systemically, but they only exert antiseptic activity when meeting with urine.

=== Compounds ===

* Methenamine (Hiprex®)
* Mandelic acid
* Nalidixic acid

=== Mechanism of action ===
Methenamine releases formaldehyde when in acidic environment, like the urine.

=== Use ===
Methenamine can be used to prevent urinary tract infections but cannot be used to treat the infections themselves.

Mandelic acid and nalidixic acid are no longer used as they are toxic.
[[Category:Pharmacology 2]]