Biguanide antiseptic for skin and mucous membranes
ATC code: D08AC02 (Chlorhexidine)
Brand names
Hibiclens, Peridex, Betasept
Cationic biguanide. Binds the negatively charged bacterial wall, disrupts membrane osmotic balance and causes cytoplasmic leakage. Bacteriostatic at low concentrations, bactericidal at high ones. Spectrum: gram-positive and gram-negative bacteria (except Pseudomonas, Proteus), Candida, enveloped viruses. Weak activity against mycobacteria and spores.
First line
First-line antiseptic for preoperative skin and hand decontamination. 2% chlorhexidine in 70% isopropanol reduces SSI risk after clean surgery vs povidone-iodine. AEMPS and SEIMC recommend it as standard for central venous catheter care.
First line
Antiseptic for acute and chronic wound care. Use 0.02–0.05% aqueous solutions; higher concentrations are cytotoxic and impair healing. SEMI recommends it for routine clean-contaminated wound care, not for deep wound cavities.
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FDA Category B. Topical use in pregnancy is safe – systemic absorption through skin is minimal. AEMPS lists chlorhexidine among standard antiseptics for perineal preparation before delivery.
Compatible. Minimal systemic absorption. eLactancia rates the risk as very low for topical use. When applied to nipples before feeding, wipe residue with warm water before latching.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Chlorhexidine is evaluated for the following indications with varying evidence strength: Antiseptic skin and mucosal decontamination (evidence tier A), Wound healing support (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Chlorhexidine (≥ 1 in 100): Itching and burning at the application site, Skin dryness and desquamation, Tooth and tongue discoloration with mouthwash use (reversible), Taste alteration. See the Safety section for uncommon and serious reactions.
FDA category B. FDA Category B. Topical use in pregnancy is safe – systemic absorption through skin is minimal. AEMPS lists chlorhexidine among standard antiseptics for perineal preparation before delivery.
Compatible. Minimal systemic absorption. eLactancia rates the risk as very low for topical use. When applied to nipples before feeding, wipe residue with warm water before latching.
Chlorhexidine is contraindicated in: Hypersensitivity to chlorhexidine (severe anaphylactic reactions possible); Use in middle or inner ear with tympanic membrane perforation; Contact with eyes or meninges. Full list in the Safety section.