Octenidine Dihydrochloride – Antimicrobial Activity, Adaptation and Clinical Application

Octenidine dihydrochloride (OCT) is an antiseptic used for the prevention of wound infections, treatment of wounds and for treating oral infections. The spectrum of OCT’s activity includes Gram-positive and Gram-negative bacteria, as well as fungi, including multidrug-resistant (MDR) strains. For most species, it exhibits activity at concentrations ranging from approximately 1 to several μg/mL. OCT also exhibits strong antibiofilm activity, both against biofilm formation and mature biofilms. The compound has limited virucidal and antiparasitic activity. The Clinical Efficiency of MIC (CEMIC) index for most pathogens is classified as excellent, meaning that the MIC is much lower than the clinical concentration. The required contact time for OCT microbicidal action is fast, at just 1 minute. The possibility of adaptation to OCT has been described; however, the Karpinski Adaptation Index (KAI) for most species is below 0.2, indicating a very low or low risk of developing clinical resistance. Only in some isolates of Proteus mirabilis and Pseudomonas aeruginosa the risk of resistance development considered moderate. According to guidelines (Statement of the Polish Wound Management Association, German Consensus on Wound Antisepsis, and International Consensus Document “Use of wound antiseptics in practice”), OCT is the first-choice antiseptic for critically colonized wounds, infection-prone wounds, burns, wounds colonized by multidrug-resistant (MDR) pathogens or infected wounds, and for the prevention of surgical site infections (SSI). OCT is also used in umbilical stump care, the treatment of oral infections, skin and mucosal candidiasis, and bacterial vaginosis.