Topical antiseptic (biguanide) Pregnancy: Safe for topical use.

Chlorhexidine (Burns / Wound Antiseptic)

Brand names: Hibiscrub, ChloraPrep, Unisept

Adult dose

Dose: 0.05% (500 micrograms/mL) — wound irrigation; 0.5–2% — skin preparation and decolonisation

Route: Topical (wound wash, skin prep, or body wash)

Frequency: Daily body wash (decolonisation); before procedures (skin prep)

Max: Use sufficient to cover area

Burns wound irrigation: 0.05% aqueous solution. MRSA decolonisation: 4% chlorhexidine gluconate daily body wash for 5 days. Surgical skin prep: 2% chlorhexidine in 70% isopropyl alcohol (ChloraPrep). IV line care: chlorhexidine-impregnated dressings.

Paediatric dose

Route: Topical

Frequency: Daily or as needed

Max: Application to affected area

Neonates: 0.5% solution for skin prep (avoid higher concentrations on fragile skin). Children: same as adults for wound use and skin prep. 4% body wash: can be used in children.

Dose adjustments

Renal

No systemic adjustment.

Hepatic

No systemic adjustment.

Clinical pearls

Never use in ears (otitis externa with perforation), eyes, or body cavities
Perioperative anaphylaxis: one of the most common agents causing perioperative anaphylaxis — have adrenaline available
Skin prep before IV line insertion: chlorhexidine in alcohol superior to povidone-iodine (reduces CLABSI)
MRSA body wash: use for 5 days with nasal mupirocin (standard decolonisation bundle)
Dental use (0.1–0.2% mouthwash): effective for gingivitis and post-surgical use

Contraindications

Eyes and ears (neurotoxic — can cause deafness and corneal damage with direct contact)
Do not irrigate body cavities (neurotoxic systemically)
Neonates <28 weeks — avoid extensive use

Side effects

Skin irritation and contact dermatitis
Tooth discolouration (with oral use)
Anaphylaxis (rare — IgE-mediated, especially with intraoperative use)
Ototoxicity and neurotoxicity (if enters ear/brain — NEVER irrigate ear canals)

Interactions

Anionic surfactants (soaps) — precipitate with chlorhexidine; rinse off before use

Monitoring

Local reaction
Anaphylaxis signs (perioperative)

Reference: BNFc; BNF; PHE MRSA Decolonisation Guidelines; NICE CG74 Surgical Site Infection. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways