# A Double-blind Randomized Trial of Oral Chlorhexidine Gluconate for Treatment of Oral Staphylococcus aureus Colonization in Healthy Children

## TL;DR

A 7-day chlorhexidine mouthwash reduced throat Staphylococcus aureus in children, potentially helping prevent recurring skin infections.

## Contribution

This is the first trial showing chlorhexidine gluconate mouthwash reduces oropharyngeal S. aureus colonization in children.

## Key findings

- CHG reduced oropharyngeal S. aureus colonization at day 8 (45%) vs. 79% with placebo.
- CHG's effect persisted at day 29, with 61% colonization vs. 85% with placebo.
- Most children who rebounded to S. aureus at day 29 had a new strain type.

## Abstract

Staphylococcus aureus is the most common cause of skin and soft tissue infection (SSTI). Nasal S. aureus colonization may precede SSTI, and decolonization may decrease SSTI risk. However, many S. aureus–colonized persons are oropharyngeally colonized, sometimes without concomitant nasopharyngeal colonization. However, there are few data on oropharyngeal S. aureus decolonization, especially in children.

We performed a prospective, double-blind, randomized controlled clinical trial of twice-daily 0.12% chlorhexidine gluconate (CHG) gargle vs a placebo for 7 days in healthy children oropharyngeally colonized with S. aureus. At each study visit (days 1, 8, 29), throat and nares cultures were performed. All S. aureus isolates underwent spa typing.

We screened 189 children, 120 (63%) of whom had S. aureus oropharyngeal colonization; of these, 67 (56%) were randomized. The median participant age was 11 years (mean, 11.7), and 27 (40%) were female. In the intention-to-treat population, oropharyngeal colonization at day 8 was 45% (15/33) and 79% (27/34) in the CHG and placebo groups, respectively (P = .004), and 61% (20/33) vs 85% (29/34) at day 29 (P = .03). Among children who were oropharyngeally decolonized at day 8 but positive for S. aureus at day 29, 8/12 (66%) exhibited a new spa type compared with baseline.

We found that a 7-day 0.12% chlorhexidine gluconate mouthwash regimen significantly reduced S. aureus oropharyngeal colonization compared with placebo. This difference persisted at day 29, suggesting that CHG mouthwash may be a promising adjunctive decolonization agent that may decrease the high SSTI recurrence risk in children.

In this double-blind, randomized trial, chlorhexidine gluconate (CHG) mouthwash significantly reduced oropharyngeal Staphylococcus aureus colonization in children compared to placebo through 29-day follow-up. CHG shows potential as an adjunct to prevent recurrent skin and soft tissue infections in children.