Antiseptic
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[[Image:ExAntiseptic.jpg|right|thumb|An antiseptic solution of [[Povidone-iodine]] applied to an abrasion]]
'''Antiseptics''' (from [[Greek language|Greek]] ''αντί'' - ''anti'', '"against" + ''σηπτικός'' - ''septikos'', "putrefactive") are [[antimicrobials|antimicrobial substances]] that are applied to living [[biological tissue|tissue]]/[[skin]] to reduce the possibility of [[infection]], [[sepsis]], or [[putrefaction]]. They should generally be distinguished from ''[[antibiotic]]s'' that destroy [[bacteria]] within the body, and from ''[[disinfectant]]s'', which destroy microorganisms found on non-living objects. Some antiseptics are true ''[[germicides]]'', capable of destroying microbes ([[bacteriocidal]]), whilst others are [[bacteriostatic]] and only prevent or inhibit their growth. '''[[Antibacterials]]''' are antiseptics that only act against bacteria.
==Use in surgery==
The widespread introduction of antiseptic [[surgery|surgical]] methods followed the publishing of the paper ''[[Antiseptic Principle of the Practice of Surgery]]'' in [[1867]] by [[Joseph Lister, 1st Baron Lister|Joseph Lister]], inspired by [[Louis Pasteur]]'s germ theory of putrefaction. In this paper he 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:
*Dr. [[George H Tichenor]] who experimented with the use of alcohol on wounds ca. 1861-1863, and subsequently marketed a product for this purpose known as "Dr. Tichenor's Patent Medicine " after the [[US Civil War]].
*[[Ignaz Semmelweis]] who published his work "The Cause, Concept and Prophylaxis of Childbed Fever" in 1861, summarizing experiments and observations since 1847.<ref>[http://qshc.bmj.com/cgi/content/full/13/3/233 ''Ignaz Semmelweis and the birth of infection control''], M Best and D Neuhauser, Qual Saf Health Care 2004;13:233-234.</ref>
*[[Florence Nightingale]], who contributed substantially to the report on the [[Royal Commission|Royal Commission on the Health of the Army]] (1856–1857), based on her earlier work
*[[Oliver Wendell Holmes, Sr.]], who published "The Contagiousness of Puerperal Fever" in 1843.
and even the ancient Greek physicians [[Galen]] (ca 130–200 AD) and [[Hippocrates]] (ca 400 BC). There is even a [[Sumerian]] clay tablet dating from 2150 BC advocating the use of similar techniques.<ref>[http://www.nature.com/jid/journal/v127/n3/abs/5700701a.html ''Inflammation in Wound Repair: Molecular and Cellular Mechanisms: Editor's Note''], Russell P. Hall, III, Journal of Investigative Dermatology (2007) 127, 514–525. doi:10.1038/sj.jid.5700701</ref>
But every antiseptic, however good, is more or less toxic and irritating to a wounded surface. Hence it is that the antiseptic method has been replaced in the [[surgery]] of today by the [[Aseptic technique|aseptic method]], which relies on keeping free from the invasion of bacteria rather than destroying them when present.
==How it works==
For the growth of bacteria there must be a certain food supply, moisture, in most cases oxygen, and a certain minimum temperature (see [[bacteriology]]). These conditions have been specially studied and applied in connection with the [[food preservation|preserving of food]] and in the ancient practice of [[embalming]] the dead, which is the earliest illustration of the systematic use of antiseptics.
In early inquiries a great point was made of the prevention of putrefaction, and work was done in the way of finding how much of an agent must be added to a given solution, in order that the bacteria accidentally present might not develop. But for various reasons this was an inexact method, and today an antiseptic is judged by its effects on pure cultures of definite pathogenic celicular single helix microbes, and on their vegetative and spore forms. Their standardization has been affected in many instances, and a water solution of [[phenol]] of a certain fixed strength is now taken as the standard with which other antiseptics are compared.
==Some common antiseptics==
*;[[Alcohol]]s: Most commonly used are [[ethanol]] (60-90%), 1-[[propanol]] (60-70%) and 2-propanol/[[isopropanol]] (70-80%) or mixtures of these alcohols. They are commonly referred to as "surgical alcohol". Used to disinfect the skin before injections are given, often along with iodine ([[tincture of iodine]]) or some [[surfactant|cationic surfactants]] ([[benzalkonium chloride]] 0.05 - 0.5%, [[chlorhexidine]] 0.2 - 4.0% or octenidine dihydrochloride 0.1 - 2.0%).
*;[[Quaternary ammonium cation|Quaternary ammonium compounds]]: Also known as ''Quats'' or ''QAC's'', include the chemicals [[benzalkonium chloride]] (BAC), [[cetyl trimethylammonium bromide]] (CTMB), [[cetylpyridinium chloride]] (Cetrim, CPC) and [[benzethonium chloride]] (BZT). Benzalkonium chloride is used in some pre-operative skin disinfectants (conc. 0.05 - 0.5%) and antiseptic towels. The antimicrobial activity of Quats is inactivated by [[surfactant|anionic surfactants]], such as soaps. Related disinfectants include [[chlorhexidine]] and [[octenidine]].
*;[[Boric acid]]: Used in suppositories to treat [[yeast infection]]s 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. Though it is popularly known as an antiseptic, it is in reality only a soothing fluid, and bacteria will flourish comfortably in contact with it.
*;[[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 [[surfactant|cationic surfactant]], similar to Quats.
*;[[Hydrogen peroxide]]: Used as a 6% (20Vols) solution to clean and deodorize wounds and [[ulcer]]s. More common 1% or 2% 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.
*;[[Iodine]]: Usually used in an [[ethanol|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 better practice. Novel iodine antiseptics containing [[povidone-iodine]] (an [[iodophor]], complex of [[povidone]], a water-soluble [[polymer]], with triiodide anions I<sub>3</sub><sup>-</sup>, containing about 10% of active iodine) are far better tolerated, don't affect wound healing negativelly and leave a depot of active iodine, creating the so-called "remanent," or persistent, effect. The great advantage of iodine antiseptics is the widest scope of antimicrobial activity, killing all principial pathogenes and given enough time even [[spore]]s, which are considered to be the most difficult form of microorganisms to be inactivated by disinfectants and antiseptics.
*;[[Mercurochrome]]: Not recognized as safe and effective by the U.S. [[Food and Drug Administration]] (FDA) due to concerns about its [[Mercury (element)|mercury]] content. Another obsolete organomercury antiseptics include bis-(fenylmercury) monohydrogenborate (Famosept).
*;[[Octenidine]] dihydrochloride: A [[surfactant|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 [[mouthwash]]es and throat lozenges, where it has a [[analgesic|painkilling]] effect as well as an antiseptic one. Example: [[TCP (antiseptic)|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).
*;[[Sodium chloride]]: Used as a general cleanser. Also used as an antiseptic mouthwash. Only a weak antiseptic effect, due to [[hyperosmolality]] of the solution above 0.9%.
*;[[Sodium hypochlorite]]: Used in the past, diluted, neutralized and combined with [[potassium permanganate]] in the Daquin's solution. It is now used only as disinfectant.
==Negative effects==
Stuart B. Levy, in a presentation to the 2000 Emerging Infectious Diseases Conference, expressed concern that the overuse of antiseptic and antibacterial agents might lead to an increase in dangerous, resistant strains of bacteria.[http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm]
==Endogenous==
The body produces its own antiseptics, which are a part of the [[chemical barriers]] of the [[immune system]]. The skin and respiratory tract secrete [[antimicrobial peptides]] such as the β-defensins.<ref>{{cite journal | author = Agerberth B, Gudmundsson G |title=Host antimicrobial defence peptides in human disease. |journal=Curr Top Microbiol Immunol |volume=306 |issue=|pages=67–90 |year=|pmid= 16909918}}</ref> [[Enzyme]]s such as [[lysozyme]] and [[phospholipase A2]] in [[saliva]], tears, and [[breast milk]] are also antiseptic.<ref>{{cite journal | author = Moreau J, Girgis D, Hume E, Dajcs J, Austin M, O'Callaghan R |title=Phospholipase A(2) in rabbit tears: a host defense against Staphylococcus aureus. | url=http://www.iovs.org/cgi/content/full/42/10/2347 |journal=Invest Ophthalmol Vis Sci |volume=42 |issue=10 |pages=2347–54 |year=2001 |pmid= 11527949}}</ref><ref>{{cite journal | author = Hankiewicz J, Swierczek E |title=Lysozyme in human body fluids. |journal=Clin Chim Acta |volume=57 |issue=3 |pages=205–9 |year=1974 |pmid= 4434640 | doi = 10.1016/0009-8981(74)90398-2}}</ref> [[Vagina]]l secretions serve as a chemical barrier following [[menarche]], when they become slightly [[acid]]ic, while [[semen]] contains defensins and [[zinc]] to kill pathogens.<ref>{{cite journal | author = Fair W, Couch J, Wehner N |title=Prostatic antibacterial factor. Identity and significance. |journal=Urology |volume=7 |issue=2 |pages=169–77 |year=1976 |pmid= 54972 | doi = 10.1016/0090-4295(76)90305-8}}</ref><ref>{{cite journal | author = Yenugu S, Hamil K, Birse C, Ruben S, French F, Hall S |title=Antibacterial properties of the sperm-binding proteins and peptides of human epididymis 2 (HE2) family; salt sensitivity, structural dependence and their interaction with outer and cytoplasmic membranes of Escherichia coli. | url=http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1223422&blobtype=pdf |journal=Biochem J |volume=372 |issue=Pt 2 |pages=473–83 |year=2003 |pmid= 12628001 | doi = 10.1042/BJ20030225}}</ref> In the [[stomach]], [[gastric acid]] and [[protease]]s serve as powerful chemical defenses against ingested pathogens.
== References ==
<references/>
* {{1911}}
{{Antiseptics and disinfectants}}
{{Throat preparations}}
[[Category:Microbiology]]
[[Category:Antiseptics]]
[[Category:Greek loanwords]]
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[[uk:Антисептичні засоби]]