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Revisiting the ocular use of chlorhexidine: an agent to remember in multidrug-resistant bacterial and fungal
Mesut Arici1,2, Mukaddes Damla Ciftci3, Ozlem Barut Selver4,5,6,7,8
1Department of Pharmaceutical Technology, Faculty of Pharmacy, Ege University, Izmir, Turkey.
Background:
Chlorhexidine, a well-established antiseptic in systemic medicine and dentistry, has long been overlooked in ophthalmology outside its role in Acanthamoeba keratitis. However, recent evidence supports its potential as an effective adjunct or alternative agent in multidrug-resistant (MDR) bacterial keratitis, where treatment options remain limited and therapeutic challenges are escalating. This review aims to revisit ocular use of chlorhexidine.
Methods:
A comprehensive search was performed in the PubMed database using combinations of the following keywords: "chlorhexidine", "keratitis", "Acanthamoeba keratitis", "fungal keratitis", "bacterial keratitis", "ocularinfections", and "antimicrobial resistance". Studies relevant to the ophthalmological use of chlorhexidine, particularlyin the context of keratitis and antimicrobial resistance, were utilized.
Results:
The results revealed chlorhexidine's antimicrobial mechanisms, ocular formulations, and clinical applications, while highlighting emerging evidence from case reports, retrospective analyses, and in vitro studies that suggest potential activity against MDR ocular pathogens, including extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Pseudomonas spp.
Conclusions:
As the threat of antimicrobial resistance rises globally, chlorhexidine merits renewed attention and clinical evaluation within ophthalmology, particularly as a viable and accessible therapeutic option in resistant infections. Although current evidence is limited to preclinical studies and case reports, chlorhexidine shows potential efficacy in MDR and may warrant further investigation in well-designed clinical trials.
Insights
Chlorhexidine shows promise for treating multidrug-resistant bacterial keratitis, an eye infection with limited options. Further clinical trials are needed to confirm its efficacy as an antiseptic agent in ophthalmology.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Chlorhexidine is a known antiseptic but underutilized in ophthalmology.
- Multidrug-resistant (MDR) bacterial keratitis presents significant treatment challenges.
- Emerging evidence suggests chlorhexidine's potential against resistant ocular pathogens.
Purpose of the Study:
- To review the ocular applications of chlorhexidine.
- To assess its potential role in managing MDR bacterial keratitis.
Main Methods:
- PubMed database search using keywords: chlorhexidine, keratitis, ocular infections, antimicrobial resistance.
- Inclusion of studies on ophthalmological use, keratitis, and antimicrobial resistance.
Main Results:
- Chlorhexidine exhibits antimicrobial mechanisms and has various ocular formulations.
- In vitro and case studies indicate activity against MDR pathogens like ESBL-producing Enterobacteriaceae, MRSA, and carbapenem-resistant Pseudomonas.
- Evidence suggests potential efficacy against extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Pseudomonas spp.
Conclusions:
- Chlorhexidine warrants renewed clinical evaluation in ophthalmology for resistant infections.
- It presents a potentially viable and accessible therapeutic option.
- Further well-designed clinical trials are recommended to validate its efficacy in MDR ocular infections.
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