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Alcohol (medicine)

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Alcohols, in various forms, are is used within medicine as an antiseptic, disinfectant, and antidote.[1] Applied to the skin it is used to disinfect skin before a needle stick and before surgery.[2] It may be used both to disinfect the skin of the patient and the hands of the healthcare providers.[2] It can also be used to clean other areas.[2] It is used in mouthwashes.[3][4][5] Taken by mouth or injected into a vein it is used to treat methanol or ethylene glycol toxicity when fomepizole is not available.[1] Aside from these uses, alcohol has no other well-accepted medical uses,[6] the therapeutic index of ethanol is only 10:1.[7]

Alcohol
Skeletal formula of ethanol
Ethanol is a commonly used medical alcohol
Clinical data
Routes of
administration
Topical, intravenous, by mouth
Drug class Antiseptics, disinfectants, antidotes
ATC code
Legal status
Legal status
Pharmacokinetic data
Metabolism Liver
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider

Side effects include skin irritation.[2] Care should be taken with electrocautery as ethanol is flammable.[1] Types of alcohol used include ethanol, denatured ethanol, 1-propanol, and isopropyl alcohol.[8][9] It is effective against a range of microorganisms though does not inactivate spores.[9] Concentrations of 60 to 90% work best.[9]

Alcohol has been used as an antiseptic as early as 1363 with evidence to support its use becoming available in the late 1800s.[10] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[8] The wholesale cost in the developing world is about 1.80 to 9.50 USD per litre of 70% denatured ethanol.[11] In the United Kingdom it costs the NHS about 3.90 GBP per liter of 99% denatured alcohol.[1] Commercial formulations of alcohol based hand rub or with other agents such as chlorhexidine are available.[9][12]

MechanismEdit

Ethanol, when used for toxicity, competes with other alcohols for the alcohol dehydrogenase enzyme, lessening metabolism into toxic aldehyde and carboxylic acid derivatives, and reducing more serious toxic effect of the glycols to crystallize in the kidneys.[13]

HistoryEdit

Alcohol has been used as an antiseptic as early as 1363 with evidence to support its use becoming available in the late 1800s.[10] Since antiquity, prior to the development of modern agents, alcohol was used as a general anesthetic.[14]

ReferencesEdit

  1. ^ a b c d British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 42, 838. ISBN 9780857111562. 
  2. ^ a b c d WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 321. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 January 2017. 
  3. ^ Hardy Limeback (11 April 2012). Comprehensive Preventive Dentistry. John Wiley & Sons. pp. 138–. ISBN 978-1-118-28020-1. Archived from the original on 18 September 2017. 
  4. ^ Moni Abraham Kuriakose (8 December 2016). Contemporary Oral Oncology: Biology, Epidemiology, Etiology, and Prevention. Springer. pp. 47–54. ISBN 978-3-319-14911-0. Archived from the original on 18 September 2017. 
  5. ^ Jameel RA, Khan SS, Kamaruddin MF, Abd Rahim ZH, Bakri MM, Abdul Razak FB (2014). "Is synthetic mouthwash the final choice to treat oral malodour?". J Coll Physicians Surg Pak. 24 (10): 757–62. PMID 25327922. doi:10.2014/JCPSP.757762. 
  6. ^ Pohorecky LA, Brick J (1988). "Pharmacology of ethanol". Pharmacol. Ther. 36 (2-3): 335–427. PMID 3279433. 
  7. ^ Becker, Daniel E (Spring 2007). "Drug Therapy in Dental Practice: General Principles Part 2—Pharmacodynamic Considerations". Anesth Prog. 54 (1): 19–24. ISSN 0003-3006. PMC 1821133 . PMID 17352523. doi:10.2344/0003-3006(2007)54[19:DTIDPG]2.0.CO;2. 
  8. ^ a b "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016. 
  9. ^ a b c d McDonnell, G; Russell, AD (January 1999). "Antiseptics and disinfectants: activity, action, and resistance.". Clinical Microbiology Reviews. 12 (1): 147–79. PMID 9880479. 
  10. ^ a b Block, Seymour Stanton (2001). Disinfection, Sterilization, and Preservation. Lippincott Williams & Wilkins. p. 14. ISBN 9780683307405. Archived from the original on 2017-01-13. 
  11. ^ "Alcohol, Denatured". International Drug Price Indicator Guide. Retrieved 8 December 2016. 
  12. ^ Bolon, MK (September 2016). "Hand Hygiene: An Update.". Infectious disease clinics of North America. 30 (3): 591–607. PMID 27515139. 
  13. ^ Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA (2002). "American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning". J. Toxicol. Clin. Toxicol. 40 (4): 415–46. PMID 12216995. doi:10.1081/CLT-120006745. 
  14. ^ Edmond I Eger II; Lawrence J. Saidman; Rod N. Westhorpe (14 September 2013). The Wondrous Story of Anesthesia. Springer Science & Business Media. pp. 4–. ISBN 978-1-4614-8441-7. Archived from the original on 18 September 2017.