Efficacy & Lathering Ability of Chlorhexidine Shampoos

In the Literature

Binversie EE, Pieper JB, Berger DJ. Evaluation of chlorhexidine-containing shampoos: in vitro efficacy against Staphylococcus pseudintermedius and lathering ability. Vet Dermatol. 2026;37(1):148-160. doi:10.1111/vde.70026

The Research …

Chlorhexidine-containing shampoos are commonly prescribed for treatment of canine superficial pyoderma caused by Staphylococcus pseudintermedius. These products contain varying concentrations of chlorhexidine (range, 2%-4%) and are made from different chlorhexidine salts (eg, gluconate/digluconate, acetate, hydrochloride). Efficacy is likely affected by shampoo formulation and variations in bathing factors, which can impact clinical outcomes.

This study compared the effect of 12 products (8 chlorhexidine shampoos, 3 nonchlorhexidine shampoos, one 2% chlorhexidine gluconate solution) on an American Type Culture Collection strain of methicillin-sensitive S pseudintermedius and an additional institutional methicillin-resistant S pseudintermedius strain in vitro. Product efficacy was evaluated by comparing each product’s minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), lathering ability, and lather stability.

All products had a detectable MIC; however, 2 of the nonchlorhexidine products had no detectable MBC. Significant differences were found between the MIC and MBC of different products independent of chlorhexidine concentration alone, suggesting antibacterial efficacy may be impacted by more than the presence or concentration of chlorhexidine. Some shampoos were shown to have significant differences in lathering ability, but there was no association between lathering ability and chlorhexidine concentration.

… The Takeaways

Key pearls to put into practice:

• Due to emerging concerns for antibiotic resistance, topical therapy is recommended for treatment of canine superficial pyoderma¹; 2% to 4% chlorhexidine-containing products are often suggested as first-choice therapies.

• Although wipes/pads, sprays, and mousses are available and effective for focal infections in areas with less hair, medicated shampoos are often the most effective products for patients with dense coats and/or diffuse infections. Patients should be bathed at least 2 to 3 times per week, with a recommended contact time of 10 to 15 minutes.¹

• Shampoo selection is often based on clinician preference, as many studies use products that are not currently available (ie, no longer in use, not geographically available). This study used products currently available in the United States, offering in vitro evidence for shampoo selection.

  • For example, 3 shampoos containing 2% chlorhexidine gluconate/2% miconazole nitrate had significantly lower MICs than the 2% chlorhexidine gluconate solution, 2% chlorhexidine gluconate shampoo, and 3% chlorhexidine gluconate shampoo. MBCs of two 2% chlorhexidine gluconate/2% miconazole nitrate shampoos were also significantly lower than the 2% chlorhexidine gluconate solution, 2% chlorhexidine gluconate shampoo, and 4% chlorhexidine gluconate shampoo.

• These data are based on in vitro results and may not directly correlate to in vivo efficacy; different bathing factors (eg, shampoo application and dilution) may affect the efficacy of antiseptic shampoos in vivo. Data evaluating best practice for at-home canine bathing techniques is limited. One study suggests pet owners should apply 1 coin-sized amount of chlorhexidine product per a 2-hand–sized area (ie, 19 mL/m²).² For best outcomes, owners should be carefully instructed on how to properly bathe their pet (ie, amount of shampoo per amount of water, contact time, frequency) when chlorhexidine shampoo is prescribed for treatment of superficial pyoderma.