I was asked to provide some comments for the local Chinese newspaper Lianhe Zaobao on antibacterial product recently, and the article was published two days ago (in Chinese). I am glad that the other people who commented, including another ID physician (Dr Changa from Raffles Hospital), a dermatologist, and a Watson’s pharmacist, all basically said the same thing, which is that “antibacterial” is unnecessary in household products.

LHZB
Screen capture of the LHZB article on antibacterial products

By far the most common antibacterial compounds incorporated into household products are triclosan and a related compound – triclocarban. These compounds can be found in products as diverse as soaps, body washes, toothpaste, toys, clothes, detergents, and cosmetics. They are widely prevalent in Singapore – as one can seen from the screenshot of Redmart (“anti-bacterial” is the second search item that pops up as one types “anti” into the search box).

redmart-antibacterial
Screen capture of the Redmart website – more than 100 anti-bacterial products available.

In September last year, the US FDA announced a ban on antibacterial soaps and washes containing 19 compounds, including triclosan and triclocarban (but not other products such as hand sanitisers or wipes), citing insufficient evidence on long-term safety. I am not aware of any local studies looking at the consumer use of these products, although there are repeated studies looking at whether these and other compounds are concentrated in our waterways and ecosystem. HSA last reviewed this issue in 2013, coming out with an advisory in December 2013 stating that there was “insufficient evidence to recommend changing consumer use” of these products.

Is there an issue with antimicrobial resistance per se? Exposure to triclosan and triclocarban will cause bacteria to develop resistance to it, which in itself is not a real problem, but some bacteria may also develop resistance to other antibiotics alongside the triclosan resistance. Take the example of a common environmental bacteria that also causes infections in people with weakened immune systems – Pseudomonas aeruginosa – the major way whereby it develops resistance to triclosan is to pump it out of the bacterial cell utilizing a multidrug efflux pump MexCD-OprJ. This pump will also remove other antibiotics (such as ciprofloxacin) that are used to treat human infections, as was shown in this old paper in 2001.

But the key understanding today is that there is virtually no situation in the household or community setting where antibacterial soaps and washes will be beneficial compared to just using plain soap and water, so there is no necessity to use such products.

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