Drugs for external use and Disinfectants

Benzoic acid + Salicylic acid
Benzyl benzoate
Calamine lotion
Cetrimide
Chloramine T = Chloramine
Chlorhexidine
Chlorhexidine + Cetrimide
Chlorine
Chlortetracycline, eye ointment
Cresol
Dakin's solution
(Ethyl) alcohol
Ethanol 70 %
Gentian violet
Iodine (alcoholic solutions)
Lysol
Merbromine
Mercuresceine sodium
Methylrosanilinium chloride
Oxytetracycline, eye ointment
Polyvidone iodine = PVI
Potassium permanganate
Tetracycline, dermal ointment
Tetracycline, eye ointment
Tosylchloramide sodium
Whitfield's ointment
Zinc Oxide (vaseline)

BENZOIC ACID + SALICYLIC ACID ointment = Whitfield's ointment

District hospital

Therapeutic action
- Antifungal and keratolytic

Indications
- Fungal infection of the skin
- Fungal infection of the scalp (tinea)

Preparation
- Ointment with 3 % salicylic acid and 6 % benzoic acid

Dosage
- 2 applications per day

Duration
- 3 weeks minimum depending on progress

Precautions
- Do not apply to open wounds or mucous membranes (mouth, nose, vagina, rectum).
- Local irritation and inflammation can occur (if a severe reaction, stop treatment).

Remarks
- Storage: exposure to high temperature may cause the active parts to separate from the mixture. Stir well before use.

BENZYL BENZOATE = BENZOATE DE BENZYLE (BBL (R)...)

Health post

Therapeutic action
-Parasiticidal preparation for external use (skin)

Indications
-Scabies
-Pediculosis (lice)

Preparation
-Emulsion containing 25 % benzyl benzoate
-Concentrated emulsion containing 90 % benzyl benzoate

FIGURE

Directions for use
-Shake well before use.
-For the treatement of scabies
Warning: in case of secondary infection, first clean and apply gentian violet for several days before applying benzyl benzoate.
· Wash the patient.
· Apply the product all over the body, except for the face and the mucous membranes.
· Leave the product on the body for 24 hours (12 hours for children under 2 years).
· Wash.
· Repeat the following morning if possible, washing the patient between the two applications.

- For the destruction of lice
· Apply the product, leave for 24 hours (12 hours for children under 2 years), wash the patient afterwards.

Precautions
-NEVER SWALLOW: VERY DANGEROUS.
-In case of ingestion, DO NOT INDUCE VOMITING, refer to a doctor.
-Do not apply to mucous membranes (mouth, nose, vagina, rectum).
-Lactation: avoid applying to the nipples.

Remarks
-Examine the other family members and treat everyone affected with scabies
simultaneously. Have the clothing and bed linen washed with boiling water.
-Itching can continue for several days which does not imply that the treatment is ineffective.
-The concentration recommended by WHO is 25 %.
Storage: no special precautions

CALAMINE lotion and Vaseline with ZINC OXIDE

District hospital

Therapeutic action
- Astringent, soothing, antipruritic
- Skin protection

Indications
- Burns
- Eczema
- Psoriasis
- Varicose ulcers

Preparation
- Calamine lotion (15 % zinc carbonate)
- Vaseline with 10 % zinc oxide, jar or tube

Dosage
- 1 to 3 applications per day

Duration
- Depending on clinical progress.

Precaution
- Clean and disinfect the skin well before applying the ointment or lotion.

Remarks
- These two products are used in the same way. In general, calamine lotion is better known in english speaking countries and zinc oxide in french speaking countries.
- Zinc oxide can be used to replace sterile paste for burns: sterilize in a pressure-cooker or heat while stirring until boiling point, allow to cool, coat the sterile compresses and apply.
- Storage: no special temperature requirements. Exposure to high temperatures may cause the active parts to separate from the mixture. Stir well before use.

CETRIMIDE (Cetavlon (R)...)

The use of this drug is not advised:
- it has almost no advantage over ordinary scop;
- the aqueous solution is very often contaminated;
- it is not included in the WHO essential drug list.

Therapeutic action
- Antiseptic detergent and disinfectant

Indications
- Cleaning of wounds
- Cleaning of dirty materials

Preparation
- Powder for dissolving
- Concentrated solution of 20 % to be diluted
- Concentrated solution of 40 % to be diluted

Dilution
- It is used in a 1 % solution of cetrimide
10 g of powder in 1 litre of water
or 50 ml of the solution of 20 % in 950 ml
or 25 ml of the solution of 40 % in 975 ml
- Prepare the solutions with drinking water from the water mains or use boiled water, filtered if necessary.
- Wash the bottle carefully with hot water and let it dry before refilling.

Precautions
- The aqueous solution diluted for use are easily contaminated by pathogenic germs (if possible, prepare the solution just before use).
- Incompatible (causes inactivation) with soap and iodine (polyvidone iodine).
- Not suitable for the sterilization of instruments (nor for sterile storage).

Remarks
- Use of the product is not advised (limited efficiency and high risk of contamination of the aqueous solutions).
- The combination of chlorhexidine + cetrimide is much more efficient.
- Storage. no special precautions
Never keep diluted solutions for more than 1 week.

CHLORAMINE = CHLORAMINE T = TOSYLCHLORAMIDE SODIUM

Health clinic

Therapeutic action
- Antiseptic and disinfectant (generates chlorine)

Indications
- Antiseptic
· Cleaning of dirty wounds
· Disinfection of wounds or infected mucous membranes (abscess, ulcers...)

- Disinfectant
· Disinfection of medical instruments
· Disinfection of floors, surfaces, various objects...

Preparation
- Powder or tablets of 250 mg, 500 mg or 1 g, with a slight odour of chlorine. The tablets must be easily and completely soluble, otherwise the powder is preferable.

Dilution
- Antiseptic
· For general use :5 g per litre
· For repeated use on mucous membranes: 2 g per litre

- Disinfectant
· Disinfection of instruments: 20 g per litre
· Disinfection of floors, surfaces, various objects: 5 g per litre

- Prepare the solutions with drinking water from the water mains or use boiled water, filtered if necessary.

Use
- For wounds and mucous membranes: bath, irrigation or compresses (solutions of chloramine are better than DAKIN). For prolonged use, protect the healthy skin around the wound with vaseline.
- Rapid disinfection of instruments and laboratory equipment: soak for 15 minutes in a solution of 20 g/litre (the instruments must be cleaned first).

Precautions
- Protect people from accidental swallowing of the tablets: DO NOT STORE NEAR ORAL TABLETS.

Remarks
- There are tablets of 12 or 20 mg for the disinfection of drinking water for individuals and families (1 tablet per litre clear water).
- 1 g of chloramine generates 250 mg of active chlorine.
- Storage:
· Storage of r eady to use solutions: maximum 1 week.
· The solutions use for soaking instruments must be renewed every day.
· The solutions must be stored in the shade and protected from direct sunlight: use an opaque bottle or brown glass (do not use a metal container).

CHLORHEXIDINE (Hibitane (R)...)

Health post

Therapeutic action
- Antiseptic

Indications
Cleaning and disinfection of:
- skin and mucous membranes
- wounds
- burns
- ulcers
- abscesss

Preparation
- Concentrated solution of 5 % chlorhexidine digluconate to be DILUTED before use. Check whether the supplied concentrated solution can be diluted with non-distilled, ordinary water (in this case, the solution must contain a cosolvent).
- There are solutions of 20 % chlorhexidine, but they contain generally no cosolvents and must therefore be DILUTED WITH DISTILLED WATER to avoid a possible precipitation of chlorhexidine.

Dilution
- Used in an aqueous solution of 0.05 % chlorhexidine = 10 ml of the 5 % solution in 1 litre of water.
- Use drinking water from the water mains or boiled water, filtered if necessary.
- Wash the bottle carefully with hot water and let it dry before refilling.

Precautions
- Do not bring into contact with cerebral tissue, the meninges or an injured ear-drum.
- Do not use with soap (rendered inactive).
- Do not use for cleaning the ears.
- Not suitable for the sterilization of instruments (nor for sterile storage).

Remarks
- The combination of chlorhexidine + cetrimide is more useful: better detergent properties (cleaning) and it can always to be diluted with non-distilled water (cetrimide operates as a cosolvent).
- Storage:
· concentrated solution: no special precautions.
· solution diluted ready for use: maximum 1 week

CHLORHEXIDINE + CETRIMIDE (HAC (R)), Savlon(R)...)

Health post

Therapeutic action
- Combination of an antiseptic and a detergent

Indications
Cleaning and disinfection of:
- skin and mucous membranes
- wounds
- burns
- ulcers
- abscesss
- various objects

Preparation
- Concentrated solution of 1.5 % chlorhexidine and 15 % cetrimide to be DILUTED before use.

Dilution
- Make a 2 % solution from the concentrate: 20 ml of the concentrated solution in 1 litre of water. This solution contains 0.03 % chlorhexidine and 0.3 % cetrimide.
- Use drinking water from the water mains or boiled water, filtered if necessary.
- Wash the bottle carefully with hot water and let it dry before refilling.

Precautions
- Do not bring into contact with cerebral tissue, the meninges or an injured ear-drum.
- Do not use with soap (rendered inactive) or with an iodine disinfectant (e.g. polyvidone iodine).
- Do not use for cleaning the ears.
- Not suitable for the sterilization of instruments (nor for sterile storage).

Remarks
- Storage:
· concentrated solution: no special precaution.
· solution diluted ready for use: maximum 1 week

Products that generate CHLORINE (Calcium hypochlorite = HTH, Chlorinated lime, Bleach, Sodium dichloroisocyanurate or NaDCC)

Therapeutic action
- Strong disinfectants (generate active chlorine)

Indications
- Disinfection of objects, instruments, linen...
- Disinfection of floors, surfaces (tables, sinks...)

Preparation
- Calcium hypochlorite grains (HTH) ..+/-70 % active chlorine
- Chlorinated lime powder, bleaching powder+/- 25 % active chlorine
- Solutions of sodium hypochlorite (bleach, Milton(R):
· Bleach 12° chlorometrical degrees .. +/- 4 % active chlorine
· Bleach 15° chlorometrical degrees ...+/- 5 % active chlorine
· Concentrated bleach 48° chlorometrical degrees... +/- 15 % active chlorine
(to be diluted in 3/4 litre water to become bleach with 4 % active chlorine)

- Sodium dichloroisocyanurate or NaDCC:
· Powder ..60-65 % active chlorine
· Tablets (Javel solid(R)) 1.5 g active chlorine per tablet

The power of the disinfectants that generate chlorine is expressed in active chlorine (generally percentage in active chlorine).

The amount of active chlorine is sometimes expressed in chlorometrical degrees.
1° chlorometrical = approximately 0.3 % active chlorine

The amount of chlorine in diluted solutions is expressed in % or in ppm (parts per rnillion) of active chlorine (1 ppm = 1 mg/litre = 0.0001%).

Dilution
-The amount of active chlorine must always be checked on the packaging of the product to correct the dosage if necessary.
-In certain conditions, solutions with a stronger content of active chlorine can be made by adjusting the dosage.
-Always dilute in non-metal containers just before use.
-A deposit in HTH or chlorinate lime solutions is normal (use the upper part). -Prepare solution with clean water.

FIGURE

Precautions
-Handle the concentrated products with care (avoid jolts and exposure to high temperatures or flames).
-Avoid inhaling vapours and dust when opening or handling the containers.
- Do not mix with detergents.
-Do not bring the dry product, particularly calcium hypochlorite, in contact with organic materials (for example: corpses): risk of explosion.
-Disinfection of linen
Only suitable for cotton and linen (but risk of discolouration). Soak for maximum 15 minutes. Do not exceed 0.1% (1,000 ppm) of active chlorine. Rinse abundantly (at least 3 times) with clear water after soaking.
-Disinfection of instruments
To avoid corrosion, use only for stainless steel instruments. Do not use solution containing more than 0.1 % (1,000 ppm) of active chlorine frequently, do not leave in contact for more than 30 minutes, instruments and solution should be cold, rinse abundantly and dry after disinfection.
-NaDCC is less corrosive than solutions of calcium hypochlorite and bleach.

Remarks
-Chloramine T (sodium tosylchloramide) also produces chlorine (25 % active chlorine), but acts more slowly than the products described above. It is especially suitable as an antiseptic for infected wounds and mucous membranes because it is less irritating.
-Calcium hypochlorite, bleach and concentrated bleach can be used to prepare antiseptic solutions (DAKIN solution) if 1 teaspoon of sodium bicarbonate is added to the final solution (to neutralise the alkalinity).
· For wounds: solution of 0.1 % (1,000 ppm) active chlorine.
· For mucous membranes: solution of 0.05 % (500 ppm) active chlorine.

- Trichloro-isocyanuric acid containing 90 % of active chlorine is very similar to NaDCC, but its use is limited by poor solubility. It is mainly used for chlorination of pool water as pellets placed in a float.
-Storage:
· Store in air-tight containers: protectedfrom light and heat (and humidityfor solids).
· Chlorinated lime, bleach and concentrated bleach are difficult to keep (maximum a few months for the last two).
· Calcium hypochlorite is relatively easy to keep.
· NaDCC is much more stable.

Soapy solution of CRESOL = Lysol

District hospital

Therapeutic action
- Disinfectant and detergent

Indications
- Cleaning and disinfection of materials (floors, objects, instruments, surfaces, linen...)

Preparation
- Concentrated solution (containing 50 % cresol and 50 % liquid soap) to be DILUTED before use

Dilution
- Dilute in water just before use: 2 to 5 % depending on amount of dirt (1 part of concentrated solution in 20 to 50 parts of water = 200 to 500 ml for 10 litres of water)

Use
- Objects and instruments
Soak in the diluted solution during 30 minutes, brush with care, rinse and sterilize if necessary.
- Rooms
Evacuate the patients, clean with the diluted solution, rinse and ventilate to eliminate the smell and irritating odour.
- Linen
Soak in the diluted solution during 6 hours, rinse abundantly.

Precautions
- Do not confuse with pure cresol, without soap (see remarks).
- Do not use for the disinfection of food, or for materials than can come in contact with drinking water or food.
- Very irritating for skin and mucous membranes:
· Never use for wounds, skin...
· Avoid contact with the hands.

Remarks
- Lyorthol (R), sodium cresylol, Cresyl (R), Creolin (R), chloroxylenol 5 %, Dettol (R), are similar products used for the same purposes and diluted in the same way, but Dettol (R) can also be used for skin, wounds and mucous membranes.
- Cresol (without soap) can be used but is not advised since it is more difficult to dissolve in water and is more irritating than the soapy solution. Furthermore, it has no detergent properties and stains linen.
- Storage: keep containers tightly closed.

(ETHYL) ALCOHOL = ETHANOL 70 %

The use of this drug is not advised for general use: it is expensive, irritating and
less effective than polyvidone iodine or chlorhexidine

Therapeutic action
- Antiseptic

Indications
- Used only for disinfection and cleaning of healthy skin before injections.

Preparation
- Alcohol of 95 %, 92 %
1 litre of 95 % alcohol contains 950 ml of pure alcohole.
Use diluted.

Dilution
- To obtain 1 litre of 70 % alcohol from 95 % alcohol, you need approximately 740 g (737 ml) of 95 % alcohol and 260 g (263 ml) of distilled or filtered water. 95 % alcohol must always be diluted 70 % alcohol has the best antiseptic strength.

Contra-indications, side-effectsÉcautions
- Do not apply to the eyes, mucous membranes, wounds or burns.

Remarks
- Can be easily replace polyvidone iodine. The use of alcohol can be justified only when it is available locally at a competitive price.
- Dilution can be expressed in % or in alcoholic degres: alcohol 95 % = alcohol 95°.
- Storage: keep below 30 C
Close bottles tightly to avoid evaporation.

Alcoholic solutions of IODINE (iodised alcohol, iodine tincture)

The use of this drug is not advised: see remarks

Therapeutic action
- Strong, rapid acting antiseptic
- Antifungal

Indications
- Disinfection of healthy skin (surgery, injection or puncture )
- Treatment of fungal skin infection.

Preparation
- Iodised alcohol (1 or 2 % in ethanol 70 or 80°)
- Iodine tincture (5 % in ethanol 80 or 90° + 3 % potassium iodine) is very concentrated preparation that should no longer be manufactured or prepared.

Precautions
- Very irritating solutions.
- Can provoke allergic reactions.
- Should not be used on wounds as it is painful and slows the healing process.
- Incompatible with mercury derivatives.

Remarks
- Alcoholic solutions of iodine have very limited use. They are very irritating, expensive and difficult to preserve; the alcohol evaporates (solutions become even more irritating as they age).
- They should be replaced by polyvidone iodine that is much less irritating and easier to preserve (see polividone iodine).
- Storage: maximum of a few weeks

MERBROMINE = MERCURESCEINE SODIUM ( Mercurochrome(R)...)

The use of this drug is not advised:
-it is toxic and allergenic;
-as an antiseptic, it is weak and expensive;
-it is not included in the WHO essential drug list.

Therapeutic action
- Antiseptic

Indications
- Disinfection of small superficial wounds

Preparation
- Powder to be dissolved
- Aqueous solutions of 1 or 2 % ready for use
- Alcoholic solutions of 2 % ready for use

Precautions
- Toxic for kidneys, nervous system and digestive system (resorption of mercury through skin).
- Allergic reactions, frequently accompanied by a sensitivity to all mercury derivatives (other mercury antiseptics, amalgam for dental applications, preservation agents in cosmetics. ..).
- Colours the skin which can mask an inflammatory reaction.
- Never use together with an iodine product (iodised alcohol, polyvidone iodine): risk of necrosis.

Remarks
- The aqueous solutions; have a very weak antiseptic capacity.
- The alcoholic solutions are more efficient but mercuresceine has such a high level of toxicity that its use, in all forms, should be banned.
-Storage:
· Powder and alcoholic solutions: no special precautions.
· Aqueous solutions: never preserve diluted solutions for more than 1 week.

METHYLROSANILINIUM CHLORIDE = GENTIAN VIOLET = GV = Crystal violet

Health post

Therapeutic action
- Antifungal
- Antiseptic
- Drying

Indications
- Treatment of fungal infections of:
· the skin
· the scalp (tinea)
· the oral and vaginal mucous membranes

- Treatment of wet dermal disorders (eczema, impetigo...)
- Treatment of burns and superficial wounds

Preparation
- Powder to be dissolved
- Solution of 0.5 %

Dilution
- It is used in a 0.5 % solution = 5 g per litre (saturated solution). Dissolve one teaspoon in 1 litre of water. Stir several times and leave to settle. Filter through cotton or pour carefully into another bottle to eliminate possible sediment.
- Use drinking water from the water mains or boiled water, filtered if necessary.
- Wash the bottle carefully with hot water and let it dry before refilling.

Use
- Apply once a day.
- The solution can be applied in the mouth without danger.

Precautions
- May cause permanent pigmentation (do not use on the face of light skinned people).

Remarks
- Storage:
· of powder: unlimited.
· solution diluted ready for use: maximum 1 week.

POLYVIDONE IODINE = PVI (Betadine (R), Videne (R)...)

District hospital

Therapeutic action
-Antiseptic and disinfectant

Indications
-Disinfection of the skin, wounds and burns
-Treatment of fungal and other skin infections, and skin manifestations caused by certain viruses (herpes, shingles...)
- Disinfection of medical instruments
- Disinfection of the hands before surgery

Preparation
- Concentrated solution of 10 % PVI to be used pure or diluted

Dilution
-Pure (= solution 10 % PVI) for the disinfection of the skin.
-Diluted to 2.5 % PVI for the disinfection of wounds, burns and instruments (1 part of concentrated solution of 10 % + 3 parts water).
-Diluted to 0.5 % PVI for the mucous membranes (1 part of concentrated solution of 10 % + 19 parts water).
- Prepare the dilutions with drinking water from the water mains or boiled water, filtered if necessary.

Use
-Disinfection of the skin
· Before injection or setting up IV catheter: one application of the diluted solution of 2.5 % PVI (if the skin is dirty, first wash with soap and water).
· Before surgery: two applications of concentrated solution (10 % PVI) after washing with soap and water, rinsing and drying.

-Disinfection of the umbilical cord
Concentrated solution (10 % PVI).
-Treatment of fungal skin infections and viral manifestations (herpes, shingles)
Concentrated solution (10 % PVI) twice a day.
-Disinfection of wounds and burns
One application of diluted solution of 2.5 % PVI every time the dressing is changed.
-Treatment of infections and fungi on mucous membranes
Diluted solution of 0.5 % PVI twice a day.
-Rapid disinfection of stainless steel instruments
Soak the clean instruments for 15 minutes in the diluted solution of 2.5 % PVI.
-Disinfection of the hands
After careful and prolonged washing with soap, and rinsing with boiled water, rub the
hands while still damp with a small amount of 10 % PVI solution until dry.

Precautions
-Do not use repeatedly on very large surfaces or with infants.
-Never use with a mercury derivative (e.g. Mercurochrome (R), certain disinfecting soaps) because of necrosis risk.
-Stop treatment if allergic reaction.

Remarks
-Relatively expensive product, but very efficient and polyvalent.
Storage:
· Concentrated solution 10 % PVI: no special precautions.
· Diluted solution of 2.5 % PVI: maximum 1 week.
· Diluted solution of 0.5 % PVI: prepare just before use.
· Solution used for the disinfection of instruments: renew every day.

POTASSIUM PERMANGANATE

The use of this drug is not advised:
-the risk of misuse is too great;
-it is not included in the WHO essential drug list.

Therapeutic action
- Antiseptic
- Astringent

Indications
- Superficial wounds .
- Eczema .
- Fungal infection, in particular of the toes (athlete's foot)

Preparation
- Dark crystal violet to be dissolved
- Tablets to be dissolved; exist in various doses: 0.25 g, 0.50 g and 1 g

Dilution
- Dilute to 0.01 % (100 mg in 1 litre water)
- The concentration must be precise:
· if it is too high: caustic
· if it is too low : inefficient
Scales must be used to obtain the proper concentration from the crystals.

Precautions
- Handle the dry product the concentrated solutions with care (burning of the skin and risk of explosion when brought in contact with an easily oxidizable material).
- Take precautions to avoid swallowing the tablets. Do not store near oral tablets, INGESTION IS VERY HARMFUL: risk of digestive perforation.
- Repeated applications will dry out the skin.

Remarks
-This product has no special advantages, except for its cheap price.
- Its use is discouraged because of constant mistakes in dilution and the risk of ingestion of the tablets.
- Storage:
· dry product: protect against air (air-tight containers).
solution diluted for use maximum 1 week.

TETRACYCLINE dermal ointment

The use of this drug is not advised:
-local applictions of antibiotics also utilised orally increase
-the risk of selecting resistent strains of bacteria.

Therapeutic action
- Antibacterial

Indications
- No indications. The use of antibacterial ointments is discouraged (risk of selecting resistant strains). Regular washing with antiseptic is often enough to heal a skin infection. If this fails, the treatment with oral antibiotics is preferable.

Preparation
- Ointment of 3 % tetracycline (tube of 15 g or jar of 1 kg)

Precautions :
- Do not apply the dermal ointment to the eyes. Use only eye ointment for the eyes.

Remarks
- Storage: keep below 30°C.
Do not use after the expiry date.

TETRACYCLINE eye ointment CHLORTETRACYCLINE eye ointment and OXYTETRACYCLINE eye ointment

Health post

Therapeutic action
- Antibacterial

Indications
- Eye infections (conjunctivitis)
- Trachoma
- Prevention of eye infections in the newborn (chlamydia and gonococcus)

Preparation
- Sterile ointment of 1 % or 3 % (tube of 5 g)

Dosage
Applied under the eyelids.
- Conjunctivitis :2 applications per day for 1 week.
- Trachoma: 2 applications per day for 4 to 6 weeks.
- Prevention of eye infections in the newborn: 1 single application at birth.

Duration
- Depending on indications

Precautions
- Allergic reactions possible. Stop treatment and refer to a doctor.

Remarks
- The ointments of 1 % and 3 % are used in the same way.
- Do not apply the dermal ointment to the eyes. Use only eye ointment for the eyes.
- The tetracycline eye ointment is better than SILVER NITRATE for the prevention of conjunctivitis in the newborn.
- Oxytetracycline and chlortetracycline are used in the same way as tetracycline.
- Storage: keep below 30°C.
Do not use after the expiry date.
After opening, close the tube well to avoid contaminahon.