Goodbye Triclosan (and Triclocarban)

Back when I was an ID fellow, I completed a national survey (along with Anthony Harris) of the availability of tricolsan and triclocarban containing antibacterial soaps. At the time, the industry wouldn't release the use or sales data we needed to estimate a population risk from these chemicals. We found that 76% of liquid soaps and 29% of bar soaps sold to consumers contained these agents. Fifteen years ago we concluded: "with limited documented benefits and experimental laboratory evidence suggesting possible adverse effects on the emergence of antimicrobial resistance, consumer antibacterial use of this magnitude should be questioned."

Well, patience is a virtue. Today, the FDA issued a rule banning triclosan, triclocarban and 17 other agents in hand soaps and body washes. The ban does not apply to antibacterial soaps used in healthcare settings. In a press release, the FDA stated:

"there isn’t enough science to show that over-the-counter (OTC) antibacterial soaps are better at preventing illness than washing with plain soap and water. To date, the benefits of using antibacterial hand soap haven’t been proven. In addition, the wide use of these products over a long time has raised the question of potential negative effects on your health."

It's nice to see positive change happen in your lifetime. It's also nice not to have to read a soap's ingredients before washing our hands.

FDA taking a closer look at Triclosan

Triclosan, one of the primary ingredients in consumer antibacterial soaps and many other products, was thought to be safe even if it might select for resistant bacteria. Recently, the FDA has updated its webpage to state that "animal studies have shown that triclosan alters hormone regulation" and "other studies in bacteria raised the possibility that triclosan contributes to making bacteria resistant to antibiotics." And on the other side of the cost-benefit equation, the FDA now states "the agency does not have evidence that triclosan in antibacterial soaps and body washes provides any benefit over washing with regular soap and water." If you're interested in reading more on the lack of benefit of antibacterial products in the consumer setting I suggest Elaine Larson's wonderful study in the Annals or even this randomized trial in the Lancet comparing regular soap to antibacterial soap in Pakistan.

Just to emphasize how important the question of triclosan's safety is, it has been shown to persist in coastal waters for up to 40 years. Thus, we have a chemical agent, that was thought to be a non-specific and safe biocide, but has now been found in almost 50% of consumer soaps, select for resistant bacteria, potentially have hormone effects, persist in the environment and have little benefit to the consumer. The FDA will report back to us in Spring 2011.