Triclosan

Not to be confused with triclocarban.
Triclosan
Names
Preferred IUPAC name
5-Chloro-2-(2,4-dichlorophenoxy)phenol
Other names
2,4,4'-Trichloro-2'-hydroxydiphenyl ether
5-Chloro-(2,4-dichlorophenoxy)phenol
Trichloro-2'-hydroxydiphenyl ether
CH-3565
Lexol 300
Irgasan DP 300
Ster-Zac
Identifiers
3380-34-5 YesY
3D model (Jmol) Interactive image
ChEBI CHEBI:164200 YesY
ChEMBL ChEMBL849 YesY
ChemSpider 5363 YesY
DrugBank DB08604 YesY
ECHA InfoCard 100.020.167
KEGG D06226 YesY
PubChem 5564
UNII 4NM5039Y5X YesY
Properties
C12H7Cl3O2
Molar mass 289.54 g·mol−1
Appearance White solid
Density 1.49 g/cm3
Melting point 55–57 °C (131–135 °F; 328–330 K)
Boiling point 120 °C (248 °F; 393 K)
Pharmacology
D08AE04 (WHO) D09AA06 (WHO) (medicated dressing)
Hazards
Safety data sheet MSDS
NFPA 704
Flammability code 1: Must be pre-heated before ignition can occur. Flash point over 93 °C (200 °F). E.g., canola oil Health code 2: Intense or continued but not chronic exposure could cause temporary incapacitation or possible residual injury. E.g., chloroform Reactivity code 0: Normally stable, even under fire exposure conditions, and is not reactive with water. E.g., liquid nitrogen Special hazards (white): no codeNFPA 704 four-colored diamond
1
2
0
Flash point 162.2 °C (324.0 °F; 435.3 K)
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
YesY verify (what is YesYN ?)
Infobox references

Triclosan, similar in its uses and mechanism of action to triclocarban, is an antibacterial and antifungal agent found in consumer products, including toothpaste, soaps, detergents, toys, and surgical cleaning treatments. Its efficacy as an antimicrobial agent, the risk of antimicrobial resistance, and its possible role in disrupted hormonal development remain controversial. Additional research seeks to understand its potential effects on organisms and environmental health.

In September 2016, the FDA announced that effective September 2017, it would prohibit the sale of "consumer antiseptic washes" containing triclosan or 18 other ingredients marketed as antimicrobials due to the FDA's findings of the lack of efficacy in these products.[1][2]

History

Triclosan (TCS) was patented in 1964[3] by Swiss company Ciba-Geigy. The earliest known safety testing began in 1968.[4] It was introduced the next year, mainly for use in hospitals, and was in worldwide production and use by the early 1970s.

In 1997 Ciba-Geigy merged with another Swiss company, Sandoz, to form Novartis.[5] During the merger, Ciba-Geigy’s chemical business was spun off to become Ciba Specialty Chemicals, which was acquired in 2008 by chemical giant BASF. BASF currently manufactures TCS under the brand name Irgasan DP300.[6]

Uses

Triclosan was used as a hospital scrub in the 1970s. Since then, it has expanded commercially and is now prevalent in soaps (0.10-1.00%), shampoos, deodorants, toothpastes, mouthwashes, cleaning supplies, and pesticides.[7] It is part of consumer products, including kitchen utensils, toys, bedding, socks, and trash bags.[7][8]

As of 2012, the technical registrant with the U.S. EPA of triclosan was antimicrobial technology company Microban.[9] The company’s website explains that antimicrobial additives are mixed in during a product’s manufacturing process and protect its surface throughout its useful life by operating on the cellular level to disrupt and prevent growth of microorganisms. According to the website, the technology is used in appliances, bathroom products, cleaning products, food storage, kitchen products, luggage, office and school products, personal care, pet products, pool and spa linings, sponges, sporting equipment, towels, vacuum cleaners, water filters and wipes.[10]

By the year 2000, triclosan and triclocarban (TCC) could be found in 75% of liquid soaps and 29% of bar soaps,[11] and as of 2014 triclosan was used in more than 2,000 consumer products.[12]

In healthcare, triclosan is used in surgical scrubs and hand washes.[13] Use in surgical units is effective with a minimum contact time of approximately two minutes.[14][15] More recently, showering with 2% triclosan has become a recommended regimen in surgical units for the decolonization of patients whose skin carries methicillin-resistant Staphylococcus aureus (MRSA).[16] Triclosan is also used in the coatings for some surgical sutures.[17][18]

Triclosan has been employed as a selective agent in molecular cloning. A bacterial host transformed by a plasmid harboring a triclosan-resistant mutant FabI gene (mFabI) as a selectable marker can grow in presence of high dose of triclosan in growth media.[19]

Chemical structure and properties

This organic compound is a white powdered solid with a slight aromatic, phenolic odor. Categorized as a polychloro phenoxy phenol, triclosan is a chlorinated aromatic compound that has functional groups representative of both ethers and phenols. Phenols often demonstrate antibacterial properties. Triclosan is soluble in ethanol, methanol, diethyl ether, and strongly basic solutions such as a 1M sodium hydroxide solution, but only slightly soluble in water. Triclosan can be synthesized from 2,4-dichlorophenol.

Synthesis

Under a reflux process, 2,4,4'-trichloro-2'-methoxydiphenyl ether is treated with aluminium chloride.[20]

Triclosan can be synthesized through a three-step process starting with 1-(2-hydroxyethyl)pyrrolidin-2-one. The 1-(2-hydroxyethyl)pyrrolidin-2-one is dehydrated with either zinc or calcium oxide into 1-vinylpyrrolidin-2-one.[21] Then, 1-vinylpyrrolidin-2-one can be reacted with 5-chloro-2-(2,4-dichlorophenoxy)phenyl acrylate in n-heptane to form triclosan.[22]

The United States Pharmacopeia formulary has published a monograph for triclosan that sets purity standards.[23]

Mechanism of action

At high concentrations, triclosan acts as a biocide with multiple cytoplasmic and membrane targets.[24] However, at the lower concentrations seen in commercial products, triclosan appears bacteriostatic, and it targets bacteria primarily by inhibiting fatty acid synthesis.

Triclosan binds to bacterial enoyl-acyl carrier protein reductase (ENR) enzyme,[25] which is encoded by the gene FabI. This binding increases the enzyme's affinity for nicotinamide adenine dinucleotide (NAD+). This results in the formation of a stable, ternary complex of ENR-NAD+-triclosan, which is unable to participate in fatty acid synthesis. Fatty acids are necessary for building and reproducing cell membranes. Humans do not have an ENR enzyme and thus are not affected.

Effectiveness

Some studies suggest that antimicrobial hand soaps containing triclosan provide a slightly greater bacterial reduction on the hands compared to plain soap.[26] As of 2013 the FDA has found clear benefit to health for some consumer products containing triclosan but not in others; for example the FDA had no evidence that triclosan in antibacterial soaps and body washes provides any benefit over washing with regular soap and water.[27]

A Cochrane review of 30 studies[28] concluded that triclosan/copolymer-containing toothpastes produced a 22% reduction in both dental plaque and gingival inflammation when compared with fluoride toothpastes without triclosan/copolymer. There was weak evidence of a reduction in tooth cavities and no evidence of reduction in periodontitis.

A study by Colgate found a significant reduction in gingivitis, bleeding, and plaque with the use of triclosan-containing toothpaste,[29] but an independent review of the Cochrane group suggests that while the reduction in gingivitis, bleeding, and plaque may be statistically significant, it may not be beneficial enough to yield clinical significance.[30]

Exposure

Humans are exposed to triclosan through skin absorption when washing hands or in the shower, brushing teeth, using mouthwash or doing dishes, and through ingestion when swallowed. When triclosan is released into the environment additional exposure to the chemical is possible through ingesting plants grown in soil treated with sewage sludge and eating fish exposed to it.[31]

An article from the American Society of Agronomy refers to a study done by Monica Mendez et al in which the researchers irrigated plants with water contaminated with triclosan and months later found it in all edible parts of tomato and onion plants. It is found to kill a wide spectrum of bacteria, and the researchers are also concerned about the effect it has on the beneficial bacteria in soil.[32][33]

Distribution, Metabolism, and Elimination

Once absorbed, humans metabolize triclosan primarily through conjugation reactions to glucuronide and sulfate conjugates that are excreted in feces and urine. Pharmacokinetic studies demonstrate that triclosan sulfate and glucuronide may be formed in the liver at approximately equal rates at the environmentally relevant concentration of 1 to 5 microMolar. When concentrations of Triclosan are below 1 microMolar, sulfonation is expected to be the major metabolic pathway for elimination.[34]

Health concerns

Because of potential health concerns spanning from antimicrobial resistance to endocrine disruption, triclosan has been designated as a contaminant of emerging concern (CEC), meaning it is under investigation for public health risk. "Emerging contaminants" can be broadly defined as any synthetic or naturally occurring chemical or any microorganism that is not commonly monitored in the environment but has the potential to enter the environment and cause known or suspected adverse ecological and(or) human health effects.[35] Triclosan is thought to accumulate in wastewater and return to drinking water, thus propagating a buildup that could cause increasing effects with ongoing use.[36]

In an article from May 2015 on the current status of triclosan, Gurpreet Singh Dhillon and colleagues cite various studies that report, “emerging health concerns related to the use of TCS such as microbial resistance, dermal irritations, endocrine disruption, higher incidence of allergies, altered thyroid hormone metabolism and tumors development due to TCS and its by-products.”[37]

Triclosan is considered safe by some but is under ongoing review by the FDA.[27] Health Canada's review concludes "that triclosan is not harmful to human health but can cause harm to the environment when used in significant amounts. This preliminary assessment confirms that Canadians can continue to safely use products such as toothpaste, shampoo and soap containing triclosan".[38]

In the United States, after a decades long review of the potential health issues from this contaminant of emerging concern, the FDA ruled on September 6, 2016 that 19 active ingredients including triclosan are not generally recognized as safe and effective (GRAS/GRAE).[39] [See policy section below].

Allergy

Triclosan has been associated with a higher risk of food allergy.[40] This may be because exposure to bacteria reduces allergies, as predicted by the hygiene hypothesis and not toxicology of the triclosan itself. This would also occur with chlorhexidine gluconate and PCMX, among other antibacterial agents.[41][42] Other studies have linked triclosan to allergic contact dermatitis in some individuals.[43][44] Additionally, triclosan concentrations have been associated with allergic sensitization, especially inhalant and seasonal allergens, rather than food allergens.[45]

By-products

Triclosan can react with the free chlorine in tap water to produce lesser amounts of other compounds, such as 2,4-dichlorophenol. Some of these intermediates convert into dioxins upon exposure to UV radiation (from the sun or other sources).[46] The dioxins that can form from triclosan are not considered to be congeners of toxicologic concern for mammals, birds and fish.[47][48]

Cardiovascular disease

The use of triclosan-toothpaste may not be associated with any increase in serious adverse cardiac events.[49]

Hormone

Concerns on the health effects of triclosan have been raised after it was detected in human breast milk, blood, and urine samples. While no human data exists, studies on rats have shown that triclosan exposure modulates estrogen-dependent responses.[50] There have been many studies performed over the years both in vivo and in vitro, in male and female fish and rats and they all support the conclusion that triclosan possesses (anti)estrogenic and (anti)androgenic properties depending on species, tissues, and cell types.[34]

Muscle Function

In a study conducted by researchers at the University of Colorado School of Medicine and the University of California, Davis, triclosan was found to impair function of cardiac and skeletal muscles, reduce grip strength in mice, and slow swimming in fish. The experiments performed by the investigators used doses of triclosan similar to those that people and animals might be exposed to during everyday life.[51][52]

Thyroid

Though studies on rats suggest the chemical can affect thyroid function, the use of triclosan toothpaste does not seem to affect human thyroid function.[53]

Environmental concerns

Treatment and disposal

The duration of triclosan in personal product use is relatively short. Upon disposal, triclosan is sent to municipal sewage treatment plants, where about 97-98% of triclosan is removed.[54] Studies show that substantial quantities of triclosan (170,000 – 970,000 kg/yr) can break through wastewater treatment plants and damage algae on surface waters.[54] In a study on effluent from wastewater treatment facilities, approximately 75% of triclocarban was present in sludge.[55] This poses a potential environmental and ecological hazard, particularly for aquatic systems. The volume of triclosan re-entering the environment in sewage sludge after initial successful capture from wastewater is 44,000 ± 60,000 kg/yr.[54] Triclosan can attach to other substances suspended in aquatic environments, which potentially endangers marine organisms and may lead to further bioaccumulation.[56] Ozone is considered to be an effective tool for removing triclosan during sewage treatment. As little triclosan is released through plastic and textile household consumer products, these are not considered to be major sources of triclosan contamination.[56]

During wastewater treatment, a portion of triclosan is degraded, while the remaining adsorbs to sewage sludge or exits the plant as effluent.[57][58] In the environment, triclosan may be degraded by microorganisms or react with sunlight, forming other compounds, which include chlorophenols and dioxins.

During 1999 to 2000, US Geological Survey detected TCS in 57.6% of streams and rivers sampled.[59]

Bioaccumulation

While studies using semi-permeable membrane devices have found that triclosan does not strongly bioaccumulate, methyl-triclosan is comparatively more stable and lipophilic and thus poses a higher risk of bioaccumulation. The ability of triclosan to bioaccumulate is affected by its ionization state in different environmental conditions.[60]

Global warming may increase uptake and effects of triclosan in aquatic organisms.[61]

Ecotoxicity

Further information: Ecotoxicity

Triclosan is toxic to aquatic bacteria at levels found in the environment. It is highly toxic to various types of algae and has the potential to affect the structure of algal communities, particularly immediately downstream of effluents from wastewater treatment facilities that treat household wastewaters.[62] Triclosan has been observed in multiple organisms, including algae, aquatic blackworms, fish, and dolphins. It has also been found in land animals including earthworms and species higher up the food chain.[54]

Triclosan favors anaerobic conditions which is typical in soil and sediment. The antimicrobial properties of Triclosan are resistant to anaerobic degradation which is the main contributor to its persistence in the environment.[63]

Resistance concerns

Concern pertains to the potential for cross-resistance or co-resistance to other antimicrobials. Numerous studies have been performed and there have been results indicating that the use of biocidal agents, such as triclosan, can cause cross-resistance. Results from a study published in The American Journal of Infection Control showed that exposure to triclosan was associated with a high risk of developing resistance and cross-resistance in Staphylococcus aureus and Escherichia coli. This was not observed with exposure to chlorhexidine or a hydrogen-peroxide based agent (during the conditions in said study).[64]

Alternatives

A comprehensive analysis in 2007 from the University of Michigan School of Public Health indicated that plain soaps are just as effective as consumer-grade antibacterial soaps with triclosan in preventing illness and removing bacteria from the hands.[65]

Nonorganic antibiotics and organic biocides are effective alternatives to triclosan, such as silver and copper ions and nanoparticles.[66]

Policy

In the U.S., triclosan is regulated as a pesticide by EPA and as a drug by FDA. EPA generally regulates uses on solid surfaces, and FDA regulations cover uses in personal care products.

In 1974, the U.S. FDA began the drug review monograph process for "over-the-counter (OTC) topical antimicrobial products," including triclosan and triclocarban. The advisory panel first met on June 29, 1972, and the agency published its proposed rule on Sept 13, 1974. The initial rule applied to, “OTC products containing antimicrobial ingredients for topical human use, which includes soaps, surgical scrubs, skin washes, skin cleansers, first aid preparations and additional products defined by the panel.”[67] The proposed rule lists dozens of products that were already on the market at the time and the firms that produced them.

In 1978 FDA published a tentative final monograph (TFM) for topical antimicrobial products. The record was re-opened in March 1979 to take into account six comments the agency received during the period for submitting objections to the TFM, including new data submitted by Proctor and Gamble on the safety and effectiveness of triclocarban and by Ciba-Geigy on the proliferation of use of triclosan. The document states that, “significant amounts of new and previously unconsidered data were submitted with each of the above petitions.”[68] It was re-opened again in October of that year to permit interested persons to submit further data establishing conditions for the safety, effectiveness and labeling of over-the-counter topical antimicrobial products for human use.

The next document issued was a proposed rule dated June 17, 1994 which states, “FDA is issuing a notice of proposed rulemaking in the form of an amended tentative final monograph that would establish conditions under which OTC topical health-care antiseptic drug products are generally recognized as safe and effective and not misbranded. FDA is issuing this notice of proposed rulemaking on topical antimicrobial drug products after considering the public comments on that notice and other information in the administrative record for this rulemaking. FDA is also requesting data and information concerning the safety and effectiveness of topical antimicrobials for use as hand sanitizers or dips.”[69] In the 1994 update to the rule, TCS was effectively removed from the drug category which made it available for use in consumer products.[70]

In 2010, the Natural Resources Defense Council forced the FDA to review triclosan after suing them for their inaction. Because the FDA prohibited hexachlorophene, a compound similar to triclosan, Halden and others argued that the FDA should also ban triclosan.[54] On December 17, 2013, the FDA issued a draft rule revoking the Generally recognized as safe status of triclosan as an ingredient in hand wash products, citing the need for additional studies of its potential endrocrine and developmental effects; impact on bacterial resistance; and carcinogenic potential.[71]

On September 6, 2016, 44 years after its initial proposed rule, FDA issued a final rule establishing that 19 active ingredients, including triclosan and triclocarban, used in over-the-counter (OTC) consumer antiseptic products intended for use with water (aka consumer antiseptic washes) are not generally recognized as safe and effective (GRAS/GRAE) and are misbranded, and are new drugs for which approved applications under section 505 of the FD&C Act are required for marketing.[72] Companies have one year to reformulate products without these ingredients, take them off the market or submit a New Drug Application (NDA) for the products. The 19 ingredients are: ◦Cloflucarban ◦Fluorosalan ◦Hexachlorophene ◦Hexylresorcinol ◦Iodine complex (ammonium ether sulfate and polyoxyethylene sorbitan monolaurate) ◦Iodine complex (phosphate ester of alkylaryloxy polyethylene glycol) ◦Methylbenzethonium chloride ◦Nonylphenoxypoly (ethyleneoxy) ethanoliodine ◦Phenol (greater than 1.5 percent) ◦Phenol (less than 1.5 percent) 16 ◦Poloxamer-iodine complex ◦Povidone-iodine 5 to 10 percent ◦Secondary amyltricresols ◦Sodium oxychlorosene ◦Tribromsalan ◦Triclocarban ◦Triclosan ◦Triple act ◦Undecoylium chloride iodine complex

In 2015 and 2016 FDA also issued proposed rules to amend the 1994 TFM regarding the safety and effectiveness of OTC health care antiseptics and OTC consumer antiseptic rubs.

The state of Minnesota took action against triclosan in advance of a federal rule. In May 2014, the governor signed a bill banning triclosan-containing products in the state. A CNN article quotes the new law, "In order to prevent the spread of infectious disease and avoidable infections and to promote best practices in sanitation, no person shall offer for retail sale in Minnesota any cleaning product that contains triclosan and is used by consumers for sanitizing or hand and body cleansing.”[73] The law goes into effect on Jan 1 2017. The exceptions to this rule are individual products that have received approval from the U.S. Food and Drug Administration for consumer use.

In light of mounting evidence on the human health and ecotoxic effects of triclosan, some companies reformulated to remove it in advance of regulation: Colgate-Palmolive removed it from Palmolive Dish Soap and Softsoap in 2011 (but it remains in Colgate Total toothpaste); Johnson & Johnson removed it from baby products in 2012 and all products in 2015; Proctor and Gamble from all products in 2014; In 2014 it was removed from Clearasil and Avon began phasing it out; and Unilever removed it from skin care and cleansing products in 2015, and says oral care by 2017.[74]

In Canada, triclosan is allowed in cosmetics, though FDA’s recent announcement has prompted Health Canada spokeswoman Maryse Durette to state in an e-mail to Toronto newspaper The Globe and Mail that, “the government will publish a final assessment of the safety of triclosan ‘in the near future’ and take further action ‘if warranted.’”[75] Health Canada maintains a Cosmetic Ingredient Hotlist, including hundreds of chemicals that are not allowed or whose use is restricted in cosmetics. The list states that triclosan is currently allowed in cosmetics up to 0.3%, and 0.03% in mouthwashes and other oral products with required warnings to avoid swallowing and not for use in children under the age of 12.[76]

Triclosan was not approved by the European Commission as an active substance for use in biocidal products for product-type 1 in January 2016.[77] In the United States, manufacturers of products containing triclosan must indicate its presence on the label. In Europe, triclosan is regulated as a cosmetic preservative and must be listed on the label.[78] Usage of triclosan in cosmetic products was restricted by the EU commission in 2014.[79]

See also

References

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  2. ↑ "FDA issues final rule on safety and effectiveness of antibacterial soaps". U.S. Food and Drug Administration. September 2, 2016. Retrieved September 8, 2016.
  3. ↑ Halden, Rolf U (March 3, 2014). "On the need and speed of regulating triclosan and triclocarban in the United States". Environmental Science and Technology. 48 (7): 3603−3611. doi:10.1021/es500495p. Retrieved October 29, 2016.
  4. ↑ Kary, Tiffany (August 11, 2014). "Cancer-Linked Colgate Total Ingredient Suggests FDA Flaws". Bloomberg. Retrieved October 29, 2016. From embedded infographic: Triclosan: Four Decades of Regulatory Limbo
  5. ↑ "Company history", corporate website, Novartis, novartis.com, archived from the original on 30 December 2010
  6. ↑ "Homecare and I & I: Irgasan DP 300". BASF.com. Retrieved October 29, 2016.
  7. 1 2 Thompson, A.; Griffin, P.; Stuetz, R.; Cartmell, E. (2005). "The Fate and Removal of Triclosan during Wastewater Treatment". Water Environment Research. 77 (1): 63–7. doi:10.2175/106143005X41636. JSTOR 25045839. PMID 15765937.
  8. ↑ Record in the Household Products Database of NLM
  9. ↑ Environmental Protection Agency. Triclosan Surface Water Modeling and Monitoring Special Studies Meeting with Microban January 18, 2012: Meeting Summary. Retrieved from Regulations.gov, https://www.regulations.gov/document?D=EPA-HQ-OPP-2007-0513-0068
  10. ↑ Our Antimicrobial Additives for Liquids, Ceramics & Textiles. Microban website. Retrieved October 20, 2016, http://www.microban.com/what-we-do
  11. ↑ Finley, Cynthia. (May 21, 2014). Washing Away Triclosan with Legislation and Regulation. National Association of Clean Water Agencies website. Retrieved from http://blog.nacwa.org/washing-away-triclosan-with-legislation-and-regulation/
  12. ↑ Halden, p. 3603.
  13. ↑ Food and Drug Administration (17 June 1994). "Federal Register Notice: Tentative Final Monograph for OTC Healthcare Antiseptic Drug Products" (PDF).
  14. ↑ Brady, L. M.; Thomson, M; Palmer, M. A.; Harkness, J. L. (1990). "Successful control of endemic MRSA in a cardiothoracic surgical unit". The Medical journal of Australia. 152 (5): 240–5. PMID 2255283.
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  16. ↑ Coia, J.E.; Duckworth, G.J.; Edwards, D.I.; Farrington, M.; Fry, C.; Humphreys, H.; Mallaghan, C.; Tucker, D.R.; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection, Society; Infection Control Nurses Association (2006). "Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities". Journal of Hospital Infection. 63: S1–44. doi:10.1016/j.jhin.2006.01.001. PMID 16581155.
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  18. ↑ Singer, Adam J.; Hollander, Judd E.; Blumm, Robert M. Skin and Soft Tissue Injuries and Infections: A Practical Evidence Based Guide. PMPH-USA. p. 95. ISBN 9781607950295. Retrieved 26 January 2016. Examples of antibacterial sutures that are coated with the antibacterial agent triclosan include... In many institutions these have replaced the comparable non-antibacterial sutures.
  19. ↑ Jang, Chuan-Wei; Magnuson, Terry (2013). "A Novel Selection Marker for Efficient DNA Cloning and Recombineering in E. Coli". PLoS ONE. 8 (2): e57075. Bibcode:2013PLoSO...857075J. doi:10.1371/journal.pone.0057075. PMC 3577784Freely accessible. PMID 23437314.
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  21. ↑ US patent 6982337, "Kahn, A.P. Production of N-Vinyl Pyrrolidone"., Apr 1, 2004.
  22. ↑ US 6315987. Nov 13, 2001.
  23. ↑ US Pharmacopoeia National Formulary. United States Pharmacopeial. 2012. ISBN 1936424126.
  24. ↑ Russell AD (May 2004). "Whither triclosan?". J. Antimicrob. Chemother. 53 (5): 693–5. doi:10.1093/jac/dkh171. PMID 15073159.
  25. ↑ The WHO Guidelines on Hand Hygiene in Healthcare (Advanced Draft), WHO, 2006, page 37 "9.9 Triclosan"
  26. ↑ Montville, Rebecca; Schaffner, Donald W. (2011). "A Meta-Analysis of the Published Literature on the Effectiveness of Antimicrobial Soaps". Journal of Food Protection. 74 (11): 1875–82. doi:10.4315/0362-028X.JFP-11-122. PMID 22054188.
  27. 1 2 "Triclosan: What Consumers Should Know". FDA. 2013-12-16. Retrieved 2014-07-15.
  28. ↑ "Triclosan/copolymer containing toothpastes for oral health". Reviews. doi:10.1002/14651858.CD010514.pub2.
  29. ↑ Rover, Jo-Ann; Leu-Wai-See, Petal (2014-06-01). "Role of Colgate Total toothpaste in helping control plaque and gingivitis". American Journal of Dentistry. 27 (3): 167–170. ISSN 0894-8275. PMID 25208366.
  30. ↑ Kraglund, Ferne (2014-03-01). "Triclosan produces statistically significant reduction in plaque, gingivitis and caries but not clinically important benefit". Evidence-Based Dentistry. 15 (1): 6–7. doi:10.1038/sj.ebd.6400980. ISSN 1476-5446. PMID 24763165.
  31. ↑ Halden, p. 3605.
  32. ↑ Izlar, Rossie. (May 25, 2016). Following Tricky Triclosan. Retrieved from American Society of Agronomy, https://www.agronomy.org/science-news/following-tricky-triclosan
  33. ↑ Mendez, Monica O., Valdez, Erika M., Martinez, Eileen M., Saucedo, Melissa, Wilson, Brittan A. “Fate of Triclosan in Irrigated Soil: Degradation in Soil and Translocation into Onion and Tomato.” Journal of Environment Quality, 2016; 45 (3): 1029 DOI: 10.2134/jeq2015.07.0386
  34. 1 2 Yueh, M., Tukey, R. H. Triclosan: A widespread environmental toxicant and many biological effects. Annual Review of Pharmacology and Toxicology. Vol. 6, 2016, 251-272. Retrieved on October 27, 2016, http://www.annualreviews.org/doi/full/10.1146/annurev-pharmtox-010715-103417
  35. ↑ Unites States Geological Survey. Contaminants of Emerging Concern in the Environment. Retrieved October 27, 2016 from http://toxics.usgs.gov/investigations/cec/index.php
  36. ↑ Food and Drug Administration. (2016) 5 Things to know about Triclosan. Retrieved from http://www.fda.gov/forconsumers/consumerupdates/ucm205999.htm
  37. ↑ Dhillon, G. S., Kaur, S., Pulicharla, R., Brar, S. K., Cledón, M., Verma, M., & Surampalli, R. Y. (2015). Triclosan: Current Status, Occurrence, Environmental Risks and Bioaccumulation Potential. International Journal of Environmental Research and Public Health, 12(5), 5657–5684. http://doi.org/10.3390/ijerph120505657
  38. ↑ "Safety of Cosmetic Ingredients". Health Canada. Health Canada.
  39. ↑ Food and Drug Administration (2016) FDA issues final rule on safety and effectiveness of antibacterial soaps. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm
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