Hexamidine: diamidine antiseptic with broad spectrum
Hexamidine (more precisely hexamidine diisethionate) is an aromatic diamidine used as a topical antiseptic with activity against a broad spectrum of bacteria and some fungi. Common formulations include skin antiseptics, eye drops, mouth washes and wound cleansing solutions. Hexamidine is widely available in France (Désomédine, Hexomedine), less so in Germany.
The activity profile is similar to other antiseptics such as octenidine or polihexanide: good antimicrobial efficacy, low skin irritation and acceptable tolerability for use in superficial bacterial and fungal infections.
Mechanism of action
Hexamidine binds to negatively charged structures on the microbial cell membrane. This interaction destabilises the membrane, alters permeability and causes loss of intracellular content. Hexamidine also interferes with essential enzymatic processes.
The spectrum covers gram positive pathogens such as staphylococci and streptococci as well as some gram negative bacteria. Many yeasts and dermatophytes are also covered. Hexamidine acts both bacteriostatically and, at higher concentrations, bactericidally.
Topical use produces high local levels with negligible systemic absorption through intact skin.
Indications
- Skin antisepsis: superficial bacterial skin infections, small wounds, abrasions, first degree burns
- Ocular antiseptic: for superficial bacterial conjunctival infections, before and after small ophthalmic procedures
- Mouth wash: for superficial bacterial mouth infections, aphthae, before and after minor dental procedures
- Surgical site preparation: in some specialised settings
- Adjunctive therapy in chronic wounds: in combination with other wound dressings
Dosing and administration
Skin antisepsis: apply 0.1 to 0.15 % solution to the affected area, one to three times daily.
Ocular antisepsis: 1 to 2 drops one to three times daily.
Mouth wash: 10 to 15 ml of a 0.1 % solution several times daily, rinse for about a minute, spit out, do not swallow.
Duration depends on indication and clinical course, generally not longer than 7 to 10 days at a stretch to avoid skin irritation or resistance.
Adverse effects
Common: mild local irritation at the application site, burning, itch.
Uncommon: allergic contact dermatitis, transient discolouration of treated skin or mucosa.
Rare: systemic allergic reactions, very rarely anaphylaxis.
Ocular use: brief burning immediately after instillation, transient blurred vision.
Mouth wash: taste changes, possible superficial tooth staining with frequent use.
Note: hexamidine is not intended for swallowing. Accidentally swallowed small amounts are usually without serious consequence.
Interactions
- Anionic substances (soaps, detergents): can weaken the effect of hexamidine; rinse residues thoroughly before use
- Other topical antiseptics: combinations may be useful but should be coordinated
- Latex materials: check compatibility
Special considerations
Pregnancy and breastfeeding: short topical use with minimal absorption is acceptable.
Children: in toddlers and infants use cautiously, avoid large areas, consult the doctor.
Storage: cool, dry, protected from light.
Ocular use: ophthalmologic assessment for chronic or recurrent eye complaints. Contact lens wearers should remove lenses before use and wait at least 15 minutes.
Mouth use: dental or dermatology assessment for chronic or severe oral mucosal changes.
Patient communication: realistic expectations of antiseptics. They reduce surface microbes but do not replace antibiotic therapy in deep or systemic infections. With increasing complaints, fever or worsening wound seek medical assessment.
Related substances
- Polihexanide, modern antiseptic with good wound tolerability
- Clioquinol, antibacterial and antimycotic topical
- Bacitracin, topical polypeptide antibiotic
- Ciclopirox olamine, topical antimycotic
Frequently asked questions
What is hexamidine used for?
Hexamidine is a topical antiseptic for superficial bacterial infections of the skin, eyes and oral mucosa. It is also used for wound cleansing and to prepare for minor procedures.
How does hexamidine differ from polihexanide?
Both are modern antiseptics with good wound tolerability. Polihexanide has a slightly broader spectrum and is used more often in wound treatment. Hexamidine is used widely in France and some other European markets, often in eye drops and mouth washes.
Can I use hexamidine mouth wash long term?
Not recommended. Antiseptic mouth washes should be used only as long as symptoms last, generally not more than 7 to 14 days. Longer use can disturb the oral flora and cause discolouration or taste changes.
What to do for allergic reactions?
Stop use immediately if rash, swelling or increased irritation appear and seek medical advice. For acute allergic reactions with breathlessness or circulatory symptoms call 112.
Sources
- BfArM German Federal Institute for Drugs and Medical Devices
- EMA European Medicines Agency
- AWMF guidelines wound care and oral hygiene
- Gelbe Liste hexamidine monograph
Legal notice and disclaimer
The information on this page is provided for general information only and does not constitute medical advice, diagnosis or treatment recommendation. It does not replace advice from a qualified physician or pharmacist. Medicines should only be used on prescription or after dispensing by a pharmacist. All information is based on the product information available at the time of writing and on recognised scientific sources; the manufacturer's current product information always prevails. Sanoliste assumes no liability for completeness, timeliness or accuracy of the information presented. In a medical emergency call the European emergency number 112.