There are many types of antibacterial products out there, and there are very little data that suggest that they’re any better than regular soap and water in terms of prevention of infectious diseases. There are potential downsides to these products as well. The FDA is looking for better data to help both the FDA and the general public weigh the risks and benefits of using these products.
In animal studies, there has been some suggestion that triclosan, a primary component in anbibacterial products, may have an effectson hormone levels, particularly thyroid hormone levels, but it has not been shown in humans. The impact on antibiotic resistance is also an important one. Triclosan has the potential to elicit resistance because it is a substrate for some resistance mechanisms, particularly efflux pumps. The concern is that increased exposure to triclosan will cause bacteria to upregulate efflux pumps, which will make them resistant not only to triclosan, but also other antibiotics.
To date, there are no definitive data that these products increase the incidence of antibacterial resistance. There have been a few small studies that look at short-term effects of exposure to triclosan-containing products, but none have shown a significant increase in antibiotic-resistant bacteria. The message there is that we don’t’ have enough information to know what the long-term impact of these products is on resistance. If you use these products chronically, there may be a cumulative effect of chronic exposure, and over time there may be emergence of drug-resistant bacteria.
Hand sanitizers, such as those used routinely in health care settings, are not included in the FDA review. As opposed to the antibacterial products being reviewed by the FDA, these sanitizers are alcohol-based and are not used with water. They play an important role in preventing transmission of infection in health care settings.
The take-home message is that the use of antibacterial products by consumers has increased significantly, although there is no evidence of their impact on the incidence infections. There is also concern that they may play a role in driving the further emergence of antibiotic resistance. The FDA is saying that we need more information on both sides of that equation. If they really play an important role in preventing household infections, then we need to define that role more clearly. If they don’t, and they’re not any more effective than regular soap and water, we need to know that also. Knowing this will help us weigh the risks and benefits of the products and help us give appropriate recommendations to our patients.
Ebbing Lautenbach, MD, MPH, MSCE
Professor of medicine
Chief of infectious diseases
University of Pennsylvania Perelman School of Medicine
Disclosures: Lautenbach reports no relevant financial disclosures.