CA2686815A1 - Therapeutic antimicrobial compositions and methods - Google Patents

Abstract

Therapeutic antimicrobial compositions and methods for providing enhanced immediate and residual anti-viral and antibacterial efficacy against rhinovirus, rotavirus, coronovirus, respiratory syricytial virus, Gram-positive bacteria, Gram-negative bacteria and combinations thereof. More specifically, therapeutic antimicrobial compositions comprising an organic acid or organic acid mixture and a short-chain anionic surfactant having at least one of a large head group; a branched alkyl chain and an unsaturated alkyl chain, and therapeutic methods of use thereof.

Description

THERAPEUTIC ANTAVIICROBIAL COMPOSMONS ANl)1VIETHODS
FIBLD OF THE INVENTION
The present invention relates to. therapeutic antimicrobial compositions and methods that provide enhanced immediate and residual anti-viral and antibacterial efficacy against rhinovin4s, rotavirus, Gratn positive bacteria, Gram-negative bacteria and combinations thereof More specifically, the present invention relates to antirnicrobial compositions comprising an organic acid or organic acid mixture, a specific, short-chain anionic surfactant having at least one of the following: a large, hydrophilic head group;
an unsaturated structure; . andlor a branched structure, and therapeutic methods of using said compositions.

BACKGROUND OF THE tNVENTION
Human and mammalian health is certainly impacted by the spread of microbial entities at home, school, work and in the environment generally. Indeed, viruses and bacteria continue to cause a variety of siclrnesses and ailments, prompting high absenteeism in schools and places of employment. ba the wake of widespread food poisoning and the Iike, the public has become even further concerned with sanitization, both of person and property. Consequently, those of skill in the art have focused their research endeavors on the identification and deployment of suitable antimicrobial compositions, and specifically those that provide immediate and residual kill of microbes, with or without the use of water.
A comprehension of the vast benefits achieved via practice of the present invention requires an understanding of the various microbes against which the present compositions are effective. Bacteria found on human skin may be divided into two groups, namely, resident and firansient bacteria. Resident bacteria are Gram-positive bacteria that establish as permanent snicrocolonies on the surface and outermost layers of the skin. Such bacteria play a fundamental role in preventing the colonization of other, more harmful bacteria and fungi. Transient bacteria are bacteria that are not part of the normal resident of the flora of the sldn. Rather, transient bacteria are deposited when airbo.rne contarninated material lands on the skin or when contarninated material is brought into physical contact with such bacteria. Transient bacteria are typically divided into two subgroups: Gram positive and Gram-negative. Gram-positive bacteria include patli.ogens such as Staphylococcus aureus, Streptococcus pyogenes and Clostridium botulinum. Gram-negative bacteria include pathogens such as Salmonella, Lscherichia coli, Klebstella, Haerriophilus, Pseudomonas aeuginosa, Proteus and Shigella dysenteriae. Gram-negative bacteria are generally distinguished from Gram-positive bacteria via the existence of an additional protective cell membrane in the former, which often results in Gram-negative bacteria being less susceptible to conventional, topical antibacterial actives.
There exist several contemporary compositions and methods for reducing and/or elirni.nating the formation of bacteria and/or viruses. For example, it is well icnown that the washing of hard surfaces, food (e.g. fru.it or vegetables) and sldn, especially the hands, with antimicrobial or noii-xnedicated soap, is effective against viruses and bacteria.
Actually, removal of the viruses and bacteria is due to the surfactancy of the soap and the mechanical action of the wash procedure, rather than the function of an antimicrobial agent. Thus, it is recommended that people wash frequently to reduce the spread of viruses and bacteria. However, many conventional products and methods of sanitization, including washing, fail to address the dilemma of sanitization "on the go", that is to say, when a consumer is removed from the benefit of running water. Those skilled in the art have attempted to resolve this dilemma via the incorporation of antimicrobial agents into disinfecting lotions, cleansing wipes and the like. Such articles reduce the need for water during or following the application of the subject composition.
Other conventional antimicrobial cleansing products include deodorant soaps, hard surface cleaners, and surgical disinfectants. These trad.itional, rinse-off antimicrobial products have been formulated to provide baateria removal during wa.shiu.g.
A few such products, including antixWcrobial soaps, have also been shown to provide a residual effectiveness against Gram-positive bacteria, but provide limited residual effectiveness against Gram-negative bacteria. By "residual effectiveness ", it is meant that the subject antimicrobial controls microbial growth on a substrate by either preventing growth of microbes or engaging in continuous kill of microbes for some period of time following the washing and/or rinsing process. To address the dilemtna of limited residual efficacy against Gram-negative bacteria, those skilled in the art have sought to incorporate high levels of alcohol and/or harsh sur.factants into contemporary antimicrobial products, which have been shown to cause dryness and irritation to skin tissues.
Thus, there remains a substantial need to identify and deploy antimicrobial compositions that may be used by consumers "on the go"; provide immediate and residual kill of microbes with or without wasliing; and prevent dryness and irritation to skin following application. Despite providing a quasi solution to the dilemma of water availability, those skilled in the art have yet to identify antimicrobial compositions that address the problerns associated with dryness and irritation to sldn. In fact, attempts to resolve this dilemma have generally resulted in the adoption of aqueous-based.
antimicrobial formulas incorporating high levels of zwitterionic surfactants that are too weak to provide significant immediate or residual benefits. Others have attempted to address the dilemma of 4ryness or irritation to skin by incorporating cationic surfactants into antinlicrobial compositions, which have been associated with adverse impacts on the environxnent and human health. Yet others still have attempted to resolve this dilemma via the incorporation of long-chain anionic surfactants into antimicrobial compositions, which are intended to prevent skin tissue penetration. Nevertheless, such surfactants are often associated with poor phase stability in produ.ct, incompatibility with commercial antimicrobial agents, and low residual kill perforiinance. Indeed, the identification of a balance between the factors of antimicrobial perÃormance, skin mildness and water availability continues to be a key concern to those of skill in the antimicrobial art.

SUIVIlVlARY OF THE 1N'VENTION
The present invention addresses and resolves all of the problems associated with the employrnent of conventional antimicrobial compositions andlor products.
Indeed, it has been surpnisingly discovered that a composition incorporating an organic acid or organic acid mixture, a specific short-chain anionic surfactant having at least one of a large, hydrophilic head group; an unsaturated structure; and/or a branched structure;
constitutes a viable advancement and altern.ative in the realm of antimicrobial fonnulations. The antimicrobial compositions of the present invention are adapted for direct application to human skin, without causing dryness or irritation.
Moreover, the antimicrobial compositions of the present invention are designed for use with or without water, and provide immediate and residual effectiveness in either instance against a variety of viruses and bacteria, including rotavirus, rhinovirus, respiratory syricytial virus (RSV), coronavirus, Grazn-positive and Gram-negative bacteria.
The specific, anionic surfa.ctant of the present invention presents a particularly novel aspect of the prescnt compositions. Those of skill in the art have generally relied upon the incorporation of longer chain (i.e. C12 to C16) anionic surfactants into antimicrobial compositions. Conventional surfactants, comparable to the acyl components found in the phospholipid matrix of the cell membrane of bacteria and virus, are thought to possess optimum antimicrobial activity with reduced skin tissue penetration. However, conventional anionic surfactants have been associated with low solubility under acidic conditions, poor compatibility with cationic antiinicrobial agents, slow dissolution kinetics and limited residual antimicrobial performance.
Against the conventional wisdom in the art, the short chain anionic surfactants of the present invention cQmprise at least one of the following characteristics:
a large, hydrophilic head group; an u.nsaturated structure; andlor a branched structure. Indeed, the surfactants of the present invention have trad.itionally been regarded_ as unsuitable for incorporation into an antimicrobial composition, based on the belief that such surfactants possess relatively low swtface activity. Contrary to the traditional wisdom, it has been surprisingly discovered that the surfactants of the present invention deliver enhanced antimicrobial efficacy a,gainst rotavirus, rhinovirus, respiratory syricytial virus (RSV), coronavirus, Gram-negative bacteria and Gram-positive bacteria. More imporlaatly, the large head group, unsaturated structure and/or branched struoture of the present surfactants reduces or liipits their tendency to penetrate skin tissue, while maximizing the ittunediate and residual effectiveness of the antixnicrobial compositions in which they are incorporated. Further, the anionic svrfaetants of the present invention exhibit stability in an aqueous product at a low pH, are compatible with cationic antimicrobial agents and convey strong residual antimicrobial activity when the substrate on which they are applied is later inoculated with virus or bacteria.
Antimicrobial compositions that provide enhanced immediate and residual anti-viral and antibacteriai officacy against rhinovirus, rotavirus, Gram-positive bacteria, Gram-negative bacteria and combinations thereof are deseribed in commonly-assigned U.S. patent publication nos. US 2003/0235550 Al to Pan et al., December 25, 2003, US 2004/0001797 Al to Saud et al., Januar1, 2004 and in January published PCT
application WO 2004/000016 A2 to Pan et al., December 31, 2003.
These antimicrobial compositions comprise an organic acid or organic acid mbciure, a specific short-chain anionic surfactant with branching or a large head group, and, optionally, a calcium ion scavenger and/or anti-foam agents.
In accordance with a first aspect of the present invention, therapeutic antimicrobial compositions and methods are disclosed. In one aspect, the presont antimicrobial compositions comprise an organio aeid or organic acid mixtnre, a specific, short-chain anionic surfactant mixture are disclosed. Suitable anionic surfactants for use in the context of the pxesent invention oomprise a chain length of from about C4 to C12 and at least one of ther following oharacteristics: a large, h,ydropliilic head group; an unsaturated structure; and/or a branched structure. In yet another aspect, the antimicrobial composixions disclosed herein optionally further cornpzise a ealoium ion scavenger and/or an anti-foam agent: The tiiarapeutio tnothods. and oompositions of the present invention'are adapted to provide immediate and residual kill ofmunerous bacteria and viruses, with or without the use of water and without oausing dryness or irritation to sldn.

rn accordance with another aspect of the present invention, there is provided a rnotlsod of treating or lrrevmting a aimobistl oaused 3u.fection in a patiW in amed thoreof, said method aharaoterized by oonapria.ing,the step of admiaieftriAg an eiNe amount of antimicrobial oomposition comprising: a. from 0.2% to 70% of an organic acid; and b. from 0.1% to 400/o of an anionic mutwtut mixture h.avin (i) a linear alkkyl ahain length of $om C4 to Cu and a total head group size oÃat Ioast 4 Angstroms; and/or (ii') a branched alkyl chain Iengdi of ;Brom C4 to C12; and/or (iii) a branched alkyl chain iengfih of from C4 to C12 and a total head group siza of at least 4 Angstcoms;
wherein said composiOm is chaxactexized by a pH of from 2.0 to 4.5.

In accordance with another aspect of the present invention, there is provided a method of disinfbcting devices ahara,etwLzed by couiprlsing treaiing a device with an effective anuount of an antimiorobial composition comprising: a. from 0.2%
to 70% of an organic aoid; and b. from 0.1% to 40 Yo of an anioruc surfaatant mixture having I. a .lio.ear alYyl chain length of from C4 to Ct2 and a total head gmup size of at least 4 Augstroms; and/or ii. a bxanohed alkyl ohain Iengah of from C4 to C12; and/or iii. a branched alkyl chain length of from C4 to C12 and a total head group sizc of at least 4 Angstroms; wherein said composition is charact+~arized by a pH of $om 2.0 to 4.5.

5a In accordance with another aspect of the present invention, there is provided a method of preventing infections oxWnating in m.edical devices in a patient in need thereof characterized by comprising disinfeoting the devices with an etfeotiUe amount of an antimicrobial connposition comprisin.g: a. from 0.2% to 70% of an organic acid; and b.
froin 0.1% to 40% of an anionic surfaetant mixture having i. a linear alkyl chain length of from C4 to C12 and a total head group size of at least 4 A.ngstroms;
and/or=ii. a.branched alkyl chain length of from C4 to C12; and/or iii. a branched alkyl chain length of from C4 tO C12 and a total b.ead group size of at least 4 Angstroms; wherein said composition is aharacterized by a piT of from 2.0 to 4.5.
These and other objeets, features, and ad.vantages will become apparent to those of ordinary skill in the art from a reading of the following detailed description and the appended claims. All percentages, ratios and proportions herein are by weight, unless otheiwise specified. All temperatures are in degrees Celsius (0 C) unless otherwise specitled.

DETAILED DESCRIPTION OP THL INVEIVT'ION
Antimicrobial- compositions that provide einhanoed immediate and residual anti-viral and antr'bacterial affcaoy against rhinovira,e, rotavinm, (3ram positive bacteri.a, Gram-negative bactesia and combinations thereof ara described in commonly assigned U.S. patent publication nos. US 2003/0235550 Al to Pan et al., December 25, 2003, US 2004/0001797 Al to Saud et al., January 1, 2004 and in published PCT
application WO 2004/000016 A2 to Pan et al., December 31, 2003.
These compositioas wam stated to have eiMcaay against gram negative and gram positive bacteria and also against vlruses. We believe that cartain formulations of these short vhain, big head surfrctant based antimiorobial compositions will be effective {

against a wide variety of pathenogenic agricultural organisms including but not limited to citrus canker.
These antitnicrobial compositions comprise an organic acid or organic acid mixture, a specific short-chain anionic surfactant with branching or a large head group, and, optionally, a calcium ion scavenger and/or anti-foam agents. For therapeutic use the formulations require in addition to the surfactant, an organic acid acid and a nonionic agent. Preferred is to use C8-AGS as the surfactant, pyrrolidone carboxylic acid as the organic acid and ethylhexyl glyoerol ethez (EHOP) as the non-ionic agent. On.e of skill in the art will recognize that other agents as disclosed in U.S. patent publication nos. US
2003/0235550 Al to Pan et al., December 25, 2003, US 2004/0001797 Al to Saud et al., January 1, 2004 or published PCT application WO 2004/000016 A2 to Pan et al., December 31, 2003 may be substituted. Preferred are compositions having greater than about 0.50% CBAQS with most preferred compositions ccintaining at least 1.25%

and a pyrrolidone carboxylio acid content of greater than or equal to 2.0%.
One of skill in the art will readily recognize that other active ingredients can be included to provide different properties or to itnprove the effectiveness of the present compositions against specific organisms. When adding other aetives, the concentration of surfactants, acids and/or non-ionic agents would also be modified to provide the degree of-activity desired. For exPnple, Parachloxometaxylenol (PCMX), a kaown antimiorobial may be added to provide another broad spectrum antimicrobial. For exmnple when adding PCMX, it is possible to reduce the amount of CBAGS below 1%
aoncentration by wseight.
Five formulations of antimicrobial compositions were created having the active agents set forth in Ta.bte 1. Water inakes up the balance of the farm.ulation.
These formulations were made in accordance with U.S. patent publication nos. US
2003/0235550 Al to Pan et aL., December 25, 2003, US 2004/0001797 Al to Saud et al., January 1, 2004 and in published PCT application WO 2004/000016 A2 to Pan et al., December 31, 2003.

`,.

Table 1.

Formula Active Com onent t fo R M $ KS KSM
C8-AGS 0.50 1.25 2.00 0.60 1.00 Coco Sulfbfatty Acid 0.40 Gluconic Acid 2.00 P o lutamic Acid CA 2.00 15.00 3.50 3.00 Suocinic Acid 1.50 2.00 Bthylhexyl Glyceryl Ether HOP 0.55 1.00 0.50 0.50 Para.chlorometaxyleno 1 (PCMX) 0.35 0.50 Potassium Sorbate 0.10 Formulation The composition of the present invention may be formulated for Etse in any manner known to one of skitl in the art. Formulations for tapical, mucosal and aerosol delivery of drugs are taught in Modern Pharmaceuttcs by Gilbert S. B~ker (IIditor), .Christa her T. Rhodes (Editor) Marcel Dekker; 4th edition (June 15, 2002) ISBN:
0824706749. Reference is also made to the International Journal of Pharmaeeutieal Compounding which can be accessed at www.ijpc.com. These sources teach and dosoribe the basics of pharmaceutical compounding. One of skill in the art will know how to take the aotive ingredients of the present invention and formulate them for dalivery. Such formulations may take the fonn. of lotions, oxntments, gels, creams, drops washes, pastes, suppositories, lozenges, mouthwashes, gargles, douches, foams, surface coatings, Iiposomes, microspheres and transdermal patches.
One of skill in the art will appreciate that the activity of the present oQmpositions can be affected throu.gh the selection of excipients to provide varying degree of skin penetration or to control release. Activity of the present formulations can be increased by occlusion of the ski.n after application with a mitable bandage or wrap. One of slciA in the art will also recognize that persistent action can be increased- by use of controlled release t.echnologies which delay release of active over time.

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The formulations contemplated herein can also be coated or otherwise incorporated into medical devices such as wipes, sponges, bandages, surgical drapes, hospital gowns, surgical gowns. Formulations can be developed that are suitable for disinfecting medical devices. Such formulations could be in the form of a liquid which could be used for spraying onto surfaces, soaking of devices, pumping through devices or incorporated into wipes for decontaminating a surface.

Testing The formulations described above were tested for 1Vlinimum Bactericidal Dilution and Residual efficacy against C. Albicans, E. Coli, S. marcesens, Methicillin Resistant Staphylococcus aureus, and E. faecalls, Mininaum Bactericidal Dilution.
Various formulations as set out in Table 2 below were tested for Miniznum Bactericidal Dilution. Organisms to be tested were grown on slants and transferred to an agar plate by strealdng to forru a lawn. Colonies are scraped off ihe agar plates using a sterile innoculating loop and suspended in phosphate buffered solution (PBS) and diluted to 5 x 106 CFUImI.

Table 2 MI1vn1ZfJM BACTERICIDAL DILõTJTIOPT

C P. S. S. aurens HTR Test C. faecalis E. colt S. aurens ~ ~~e alblcans ~} 11229 aerug[nosa marcescens 6538 ~A~
10231 51~ 15442 14756 33591 0.1%
BHOP, 1,25% ~b.o~.oa 1:8 1:8 1:16 1:2 Undiluted Undiluted AGS, 8.5a/a P
1% BHOP, 5%
2 AGS, Inhfbitioa 1:2 1:16 1:8 1:4 lnb ibition Uadiluted 2a/o PCA
0.1%
3 SHOP, 2a/o No 1:4 1:16 1:16 1:4 1:2 1:2 AGS, Inhibition 15a/o PCA

~

MINIMUM BACTERICIDAL DILUTION

E. S.aureus HTR Test C' fa~calis E. coll P. S. S. aureus albicans aeraginosa marccscens 6538 (MRSA) # Article 10231 ~) 11229 15442 14756 33591 0.1%
EHOP, 4 0.5% ~}u ~.oii Undiluted Undiluted 1:2 1:8 Undiluted 1:4 AGS, 15%
PCA
0.1%
BHOP, 2% No 1:4 1:2 1:8 1:8 1:2 1:8 AGS, Inhibition 2% PCA
0.55% 1:1024 BHOP, No 1:4 6 1.25% Inhibition ):32 1:4 1:8 Undiluted 1:16 AGS, 1:4 15% PCA
0.1%
EHOP, No No 7 0.5% Inhibition Undiluted 1:8 1:8 Undiluted inhibition Iflbibition AGS, 2% PCA
1% BT1OP,, 8 2% AGS Undiluted 1:32 1:32 1:64 1:64 1:16 1:2 15% PCA.
1% BHOP, 1:16 1:16 1:8 1:8 1:16 1:16 9 2% AGS, No 2 o PCA Tnhibition 0.55%
BHOP, 2% Undiluted 1:16 1:32 1:4 1:2 1:4 1:8 AGS, 8.5% PCA
1% BHOP, 11 A~ Undiluted Undiluted 1:2 1:4 1:4 1:4 1:8 8.5% PCA
0.55% 1:16 EHOP, 1:4 12 1.25% Undiluted 1:2 1:8 1:2 1:4 1:8 . AGS, 1:2 8.5% PCA
0.55%
EHOP, 13 1.25% ~ib'ition 1 t 16 1:8 1:4 1:4 1:4 1:4 AGS, 2%
PCA
0.55%
BHOP, 14 0.5% ~ ti.on 1:2 Undiluted 1:8 1:4 Undiluted Undiluted AGS, 8.59/o PCA

1% BHOP, A'GS Inhib tion Undiluted Undiluted 1:4 1:16 Undiluted Undiluted 15% PCA
0.55% 1:32 BHOP, i:4 16 1.25% Inhibition 1'8 1:16 1:32 Undiluted 1:2 AGS, Undiluted 8.5% PCA
0.55% 1:2048 EHOP, 1:4 17 1,25 fo ~;b ition 1:32 1:8 1:32 1:8 Undiluted AGS, 1:8 8.5% PCA
0.55% 1;256 1:32 EHOP, 18 1.25% N 1:2 1:16 1:4 1:8 1:4 1:8 AGS, ~ibition 1;2 1:4 8.5% PCA
0.55% 1:4 1:256 EHOP, Na 1:2 1:4 19 1.25% Inhibition 1:8 1:2 Undiluted 1:2 AGS, 1:2 1:4 8.5% PCA
0.55% 1:2048 BHOP, 1:16 1.25'/o ~blo tion 1:16 1:32 1:2 Undiluted 1:2 AGS, 1:4 8.5% PCA
21 ChloraPr 1:4 1:4 1:64 1:2 12 1:32 1:8 In Vitro Time Kill Candida Albicans was cultured under appropriate conditions. (current USP
procedures for culturing organisms is appropriate.) Incubation period varies (typically 120 hours at 25 C +/- 1 C) to a density of between 1.0E+06 - 1.0E+07 CFUs/mL.
Actual CFUs/rnL of starting cultures were determined by serially diluting and plating an aliquot (typically plate 10O, 10'$, 10-4, 10O, 10"a dilutions). A 50p1 aliquot of the yeast culture was pipetted into 5.OmL of the antimicrobial solution(s) in a sterile scintillation vial (organisms: solution ratio = 1:100) and mixed thoroughly by vortexing. Test inoculum level was - 1.0E+04-1.0E+05 CFUs/rnL. At the predeterxnined time point(s), 1 mi.n, 5 min, and 10 min, a 0.5mL aliquot of the inoculated antinaicrobial solution is pipetted into 4.5mL of Dey/Engley (D/E) neutralizing broth (ratio =1:10) and mixed by vortexing. An aliquot of the neutralized sample including yeast was plated onto a Sabouaud Dextrose Agar (SDA) plate using stAndard pour plate techniques. The SDA plates were incubated at 25 C+I- 1 C for 5 days (-120 hours) and CFU's are counted. CFUs/mL for organism cultures are calculated and compared to CFUs/mL for antim.icrobial solutions to determine the log reductions.

Residual Skin Testing Residual skin testing was perfonned by evenly coating the surface of a skin patch with 20 1 of the active solution. Skin samples were allowed to evaporate for 1 xninute, 15 minutes , 60 minutes, 120 minutes, 240 minutes,360 minutes, 480 minutes, and 14 hours with the lid off the Petri plate. At the appropriate time point, skin samples were inoculated with 10 1 of a 1:10 dilution of the 18-hour microbial suspension (-1.OB+08 CFUs/mL), evenly covering the entire area and the sample recovered and allowed to sit 5 minutes. At this time the skin was extracted using sterile forceps and placed in a steril centrifuge tube.
Containing 10m1 of a sampling solution and vortexed for 30 seconds. An aliquot of the extracted sample containing any n-izcrobials from the slcin was plated onto a trypticase soy agar plate using a spiral plater (typically SO I in exponential mode).
The agar plates were incubated at 37 C overnight (-18 hours) and CFUs are counted.CFUs/mL established by Baseline Count arc calculated and compared to CFUs/ml, for antimicrobiai/bacterial solutions to determine the log reductions.
The Baseline Count was achieved by evenly spreading 10 1 of the diluted bacterial suspension on a square of the Sldn and processed in accordance with the above procedure, except no active solution was added.

T2st results Anti-Fungal/Yeast A&jj~y Formulas R, M, H, KS and KSM were tested against Candida albicans and compared for activity with Chloraprep. The antifungal properties of these formulations were previously untested and unknown. In vitro time kill testing was performed as described above. The result of the testing are set forth in Table 3.

Table 3 In vitro time-kill of C. albicans 10231 Minutes of contact time (log reduction &om log 5.0 titer Formula sample 1 5 10 ChloraPrep 70% alcohol + 2% CHG 4.8 4.8 4,8 KSM 4.8 4.8 4.8 M 1.3 4.8 4.8 RID 0.3 0.9 1.0 Residual Skin efficacy testing against C. albicans was performed as set forth above. The data are set forth in Table 4 below.

Table 4 Candida albicans (C. albicans 10231) Residual Efficacy Chlora- RID M H KS .. KSM.
Log Reduction prep 1 min 3.6 0.8 2.3 3.4 3:6 3.6 =
15 min 2.2 1.1 2.7 . 3.9 3.6 . 3.6.
60 min 2.5 0.9 2.9 3.916 3.6 120 min. 1.8 2.1 3:2 . 3.9 .' . 3.6 3.6 240 min 1.1 0.2 2.7'. . . . 3.9, .3.6 . . 3..6'.

The above data show that medically acceptable strengths of RID kill candida.
Faster lo.ll, but not more residual activity can be obtained by adding lcnown broad spectrum antimicrobial (PCMX).

E. oli Formulas R, M, H, KS and KSM were tested against E. coli and compared with Chloraprep. Residual Skin efficacy testing against E.Coli was performed as set forth above. The data are set forth in Table 5 below.

Table E. coli (E. coli 11229) Residual efficacy testine.

Chlora- RI1') lYX H KS KSM
Log Reduction prep 1 min 4.6 0.6 4.6 : 4.6 '== .4.6 4.6 15min 4.5 2.7 .4.6 ~= =4.6- 3.7 4.5 60 min 4.1 4.5 '= 4.6 4.6 . 4.6 ,. -4:6 120 min 3.3 3.7 ., 4.6 . 4.2 . 4.6 =: 4.6 240 xnin 3.9 4.0 4.f 4.1 4.6' =.'.4.6 Serratia marcesens (S. marcesens 14756) Formulas R, M, H, KS and KSM were tested against S. marcesens and compared with Cbloraprep. Residual Skin efficacy testing against S. marcesens was performed as set forth above. The data are set forth in Table 6 below.

Table 6 S. marcesens 14756 Residual Efficacy Results Chlora- RID M H , KS RSM
Log Reduction prep 1 rn.in 1.8 0.1 3.6= 6.0 = 5,1 5:1 15mim 0.7 0.1 =3.6 ':6.0- .5:1'=' 5.1 60min 2.0 0.9 2.0 ~ 6.0 4.5.: 5.1.-1,20 min 1.1 0.0 . 3.7 '. `' 6.0 = '=.5.1 5.1 240 min 1.0 0.2 2.8 =' 6.0 Methicillin Resistant Staphylocaccus aureus (NL+RSA) Formulas R, M, H, KS and KSM were tested against MRSA and compared with Chloraprep. Residual Slciu efficacy testing agaainst MR,SA was performed as set forth above. The data are set forth in Table 7 below.

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Table 7 MRSA (S,zaureus 33591) Residual EMcacy Results Chlora- R M H KS KSM
Log Reduction prep = ' 1 min 5.5 1.3 0.9 4.9 5.1 5.1 15 nzin. 1.4 0.2 0.6 3.9 ='. 5.0 = -4.9' 60 min 2.7 0.1 0.6 2.9 '=. 5.8 - 4.9 120min 3.9 0.3 1.3 4.0 4.8 4.5 240 min 3.7 0.4 1.7 4.6 SØ 4.8 Vancomvcin Resistant Enterococel fVRE) Formulas R, M, H, KS and KSM were tested against E. faecalis and compared with Chlora.prep. Residual Skin efficacy testing aga.inst E. faecalis was performed as set forth above. The data are set forth in Table 8 below.

Table 8VRE (E. faecalis 51299) Residual Efficacy Results Chlora= RII) ;.GMP' /.'GMP I GMF I.. GMP /
Log Reduction re M H : KS K3M=. ' I min 4.3 0.5 ,.4:7 4.7= 4.8'. .. . 4.8' 15n1in 1.1 1.3 4.5. 4.7 ' ' 4:8' '=4.4 60 min 1.5 2.0 4.7 4.7 4.8 4.8 120 min 1.7 2.8 4.7, ' 4,7 =4.6 4.8 ' 240 min 3.2 0.6 4.T 4:7 : 4=.$ . 4.8 Therapeutic examples Example 1 Acne Acne is a common disease affecting millions of Americans every year. The condition is characterized by lesions or pimples caused by infection with P.
acnes and/or P. granulosum bacteria. Common treatment is with topical retinoids, steroids, antibiotics, and topica.l counterirritants such as sulfur, benzoyl poroxide and/or alcohol and/or use of systemic antibiotics.
Acne could be treated and its spread prevented by topical administration of the fornaulations disclosed herein in a bar, pledget, lotion, gel, or cream.

(._..

Example 2 Atopic dermatits Atopic dermatits is a condition affecting 3-10% of the US. It most commonly affects young children and is characterized by scaly patches, small vescicles, excoriations, crasting, impetiginization caused by the presence of S. aureus in the horny layer of epidermis. Current treatznent is with emollients, topical corticosteroids and/or topical or oral antihistarnin.es. Severe cases may also be treated with UV-B
phototherapy, psoralen + UVA, oral corticosteroids.
Antiniicrobial compositions of the type disclosed herein have been shown to be useful in killing S. aureus bacteria. Atopic dermatits could be treated and its spread prevented through formulations of the present invention for topical administration in a soap, pledget, lotion, gel, or cream.

Example 3 Blepharitis Blepharitis causes lifelong chronic inflaxnmation of eyelids is caused by Staphylococcus or yeast colonization on eyelid margins. Transmission is possible by touch. Current treatment includes use of warm compresses 'and lid scrubs. See, Harrison's Principals of Internal 1VXedicine, '15th Edition.

Antimicrobial compositions of the type disclosed herein have been shown to be useftil in killing S. aureus bacteria. Blepharitis could be treated and its spread prevented through formulations of the present invention for topical administration in ointments, drops, or other fomulations suitable for ocular administration.
Example 4 Dtaper Rash/Dermatit;is Diaper rash is caused by irritation from contact with urine and stool that leads to redness and breakdown of skin. Frequently accompanying common diaper rash is diaper dermatitis. Diaper derma.titis is most frequently caused by strains of the ftuigus Candida.
Secondary bacterial infections of staphylococeus and enterobacter are also possible.
Current treatments include zinc oxide cream and topical antifungal agents. It is believe that 20% of infants within firat 2 years Only 10% of cases are reported. See Cecil Textbook of Medicine 22ad Edition 2004.
Treatment andlor prevention of the primary candida infection should be possible by use of the present form.ulations in by application. Antimicrobial compositions of the ~..

type disclosed herein have been shown to be useful in killing candida, S.
aureus and enterobacter bacteria. Diaper rash and dermatitis could be treated and its spread prevented through formulations of the present invention for topical administration in a bar, pledget, lotion, gel, ointment or cream.

Example 5 Fungal skin Infections A variety of slsin infections are cause by fungal infection Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosunn, denzratophytes, yeasts and molds. Athlete's foot (tinea pedis) and nail fungus being among the more common.
Athletes foot is conunonly treated with antifixngal creams, sprays and powders, oral medications. Nail fungus and toenail fungus in particular are more difficult to treat due to the protective nail. Common OTC nail creams and ointments are relatively ineffective.
Oral antifungals such as itraconazole offer good efficacy but are expensive.
See Cecil Textbook of Medicine 22nd Edition 2004.
Fungal skin infections could be treated and its spread prevented through formulations of the present invention for topical administration in a bar, pledget, lotion, gel, ointment or cream.
Example 6 Impetigo Impetigo is the most common bacterial sldn infection in children. This disease is characterized by various skin lesions, including bulla, vesicles and blisters caused by S.
aEUreus and/or Streptococcus. ITnpetigo contagiosa is the most common form, first appearing as blisters or red sores. Eventually, the blisters rapture and ooze a fluid that forms a ccust over the affected area. The sores may tend to itch, but generally do not cause pain although there may be swollen lymph nodes in the affected area.
Impetigo contagiosa is highly contagious and is readily spread to other parts of the body through touching or scratching the sores. It is also readily spread to others through personal contact and by sharing items with an infected person.
Impetigo contagiosa is readily treated through improved hygiene and topical antiobiotic ointments and/or oral antibiotics. Iu most cases, healing begins within three days of treatment. Though it is seldom serious, this infection can sometimes lead to complications, such as scarring, if left untreated. See Cecil Textbook of Medicine 22nd Edition 2004 and MayoClinic.com.

We believe that form.ulations of the present invention will treat and prevent impetigo by killing and stopping the transfer of S. aureus and other bacteria.
Impetigo could be treated and its spread prevented through forrnulations of the present invention for topical administration in a bar, pledget, lotion, gel, ointment or cream.

Example 7 Thrxish Oropharyngeal candidiasis (OPC) or thrush is a candida fungal infection of the mouth, throat and/or tongue. It is common in newborns, infants, and older adults, but can occur at any age. Thrush due to T-cell dysfunction is the most common opportunistic infection in HIV affecting 80-90% of all patients with advanced stages of HIV
infection.
Thrush is commonly treated with nonprescription and prescription antifungals and in HN
infected patients through the concommitant use of oral azoles, and possibly intrvenous amphotericin in severe refractory cases. See Cecil Textbook of Medicine 22nd Edition 2004.
Thrush can be difficult to treat in infants due to the many places that candida species can hide. Reinfeotion may occur from toys, pacifiers, arother's breast, etc.
Because of the fast rate at which yeast multiply, Cunrent therapies inolud treatment with nystatin 4-8 or more times per day. The residual action of the present compositions should reduce frequency of application and improve rate of recovery by reducing ability of candida to hide and spread. Preferential application is topical application to mother's breasts, infant pacifiers and to swab affected areas of the mouth. Adults may also be treated in the same manner as well as with mouthwashes and gargles.

Example 8 Trachoma Trachoma is chronic conjuctival inflammation cause by C. trachomatis. It is common in developing world countries and is the cause of at least 4 million cases of blindness and 5 million cases of low vision. Current treatanent is through surgury of the eyelid and topical antibiotics. See Cecil Textbook of Medicine 22nd Edition 2004.

Formulations of the present invention can be applied as drops or ointment to the eyes to treat and/or prevent spread of trachoma.

Example 9 Warts Warts are hard growths on sldn cause by the Human papillomavirus. The primary treatment means is topical treatmentwith salicylic acid. See Cecil Textbook of Medicine 22nd Edition 2004.
Warts could be treated with the antiviral compositions of the present application through any topical formulation and/or use of treated bandages.
Example 10 Avian Flu/Influenza Avian flu is a highly infections and frequently fatal virus caused by Tnfluenz,a A..
Its fatality rate is 33% vs. 10% for SARS. Treatment consists of destroying infected birds and decontaminating tools and clothing that may have come in contact with the virus using bleach solutions. See the World Health Organization Avian Influenza Fact Sheet 2004 available at http://www.who,int/mediacentre/factshects/avan-influenza/en/.
Formulations of the present invention could be administered to affected livestock via sprays to treat and prevent the spread of outbreaks. The present invention can also be used for decontamination of skin, clothing and tools by topical application, spray or wipes.
Formulations of the present invention can also be used to kill SARS, T-IBV, HPV, H1V and Example 11 Foot and mouth disease Foot and mouth disease is a rapidly spread aphthovirus infection of cattle and swine that causes fever and blistering. Treatement is by culling and disposing of infected animals. Formulations of the present invention could be topically applied to animals, people and related materials and tools to prevent the spread of the virus.
Example 12 Mastitis Bacterial infection cause inflammation, tenderness and pain in the udders of cows caused by S. agalactia, S. aureus, and/or mycoplasma. If untreated, mastitis can lead to destruction of the udder, lost productivity and infected milk. Current treatments include discinfecting teats with iodine after milking and culling anitnals with chronic cases, and treatment with topical and systemic antibiotics. Hygiene plays a significant role in preveating the disease. See the Merck Veterninary Manual, Eighth Edition, Forbes, January 1998; The Knoxville News-Sentinel, November 2002; UGA Animal & Dairy Science Annual Report 1995, Analysis of Mastitis Costs (Eberhart et al., 1987); Animal Pharm Reports - Mastitis: Challenges and Opportunities, 2002 (Executive Summary).
Forxnulations of the present invention can be used to topically treat the udder.
Example 13 Chemical sterilization Provide alternative to existing chemical sterilants, which cause safety concerns for healthcare lab workers and corrosion of instruments with motors, moving parts and nonmetal (e.g., plastic) interfaces. Devices to be sterilized could be soaked, washed, wiped, sprayed or flushed with compositions of the present invention.
Depending on the application, it may be necessary to use a sterile water or saline flush to remove any residual actives. Potential uses include any surface or device needing sterilization including but not limited to analytical equipment, robotic devices, vital signs monitoring lead wires and instruments, etc.
Example 14 Impregnated or coated patient care or personal hygiene devices Many medical flevices or personal care products are impregnated with chlorhexidine gluocnate (CHO). CHG has been shown to cause hypersensitivity reactions when used in intravenous catheters, topical antimicrobial skin dressings, and implanted antimicrobial surgical mesh. Formulations of the present invention are believed to be ultra mild and benign to the skin, Therefore, forxnulations of the present invention could be used to create an active barrier on commonly used devices in contact with patients.
Any medical device in contact with a patient can be potentially coated with the present formulations. For example, ventilator infections affect 35% of all mechanically-ventilated patients, are associated with 330/6,35% rnortality, and increase stays in ICUs by an average of 13 days. Ventllator tubing could be treated with formulations of the present invention to reduce or eliminate source of infeotion. Sirnilarly, ECO lead sets and other reusable.
Example 15 Persoiial Care products Formulations of the present invention can be impregnated or coated on any personal care product in contact with slcin or mucous membrane. Potential uses include device needing sterilization including but not limited to tampons and sanitary napkins, paper towels, toilet tissue, diapers, bandages, clothing, bed sheets, masks, surgical drapes, etc. For example, impregnated tampons could actively inhibit growth of group A
streptococoal bacteria that cause toxic shock syndrome.

Example 16 Condom coating Forrnulations of the present invention are also suitable for coating condoms to prevent spread of sexually transmitted bacterial viral or fungal diseases, inciuding but not limited to gonnorhea, syphilis, HN, and HPV. Such formulations could be added during manufacturing or incorporated into lubricating gels or lotions for application during use.
Care must be taken to choose excipients that are not damaging to the condom materials.
Example 17 F'eminfine hygiene products Products of the present invention can also be foxmulated as a douch, gel, lotion or foam to treat or prevent urinary tract infections ("UTIs"), toxic shock and prevent the spread of sexually transmitted diseases. The most common cause of UTIs is E.
coli bacteria. Using diaphragms, spermicide-coated condoms, and in-dwelling catheters can increase the risk of UTIs. Women often develop a UTI when they b come sexually active because the b$.cteria from the vaginal area may be pushed into the urethra.
Formulations of the present invention can be coated on diaphrams, sponges prior to insertion.
Formulations in the form of a douche or wash can be used to cleanse the vaginal canaL
Formulations of the prosent invention could be packaged in individual dosage forms for use immed.iately prior to sexu.al..contact and could include dosage forms suitable for application to diaphram or condom and suitable for disinfecting skin.
Example 18 otic golution$
Formulations o,f the present invention can be formulated for use in the ears to prevent or treat swimmers ear, and microbial ear infections.
&amnle 19 Body washes and Shamuoos Formulations of the present inventions can be incorporated into therapeutic shanpoos for use in humans or aniinals to treat diseases of the skin eaused by microbial organisms.
The citation of any docunient is not to be construed as an admission that it is prior art with respect to the present invention. To the extent that any meaning or definition of a term in this written document conflicts with any meaning or definition of the term in a document cited herein, the meaning or definition assigned to the term in this written document shall govem.

While particular embodiments of the present invention have been illustrated and described, it would be obvious to those slcilled in the art that various other changes and modifications can be made without departing from the spirit and scope of the invention.
It is therefore intended to cover in the appended claims all such changes and modifications that are within the scope of this invention.

Claims (18)

1. A method of disinfecting devices comprising treating a device with an effective amount of an antimicrobial composition comprising:
a. from about 0.2% to about 70% by weight of an organic acid; and b. from about 0.1% to about 40% by weight of an anionic surfactant mixture having:
i. a linear alkyl chain length of from C4 to C12 and a total head group size of at least about 4 Angstroms; and/or ii. a branched alkyl chain length of from C4 to C12; and/or iii. a branched alkyl chain length of from C4 to C12 and a total head group size of at least about 4 Angstroms;
wherein said composition is characterized by a pH of from about 2.0 to about 4.5.

2. The method of claim 1, wherein said anionic surfactant is selected from alkyl glyceryl sulfonate, alpha sulfo fatty acid, alkyl phosphonate, branched alkyl sulfonate, branched alkyl benzene sulfonate, secondary alkyl sulfate, mono ester of alkyl sulfosuccinic acid, alkyl isethionate, alkyl amidosulfonate, and combinations thereof.

3. The method of claim 1 or 2, wherein said anionic surfactant is substituted with a sulfonate, sulfate or phosphonate group.

4. The method of any of claims 1 to 3, wherein said organic acid is selected from pyroglutamic acid, adipic acid, gluconic acid, gluconolactone acid, glutamic acid, glutaric acid, glycolic acid, tartaric acid, ascorbic acid and combinations thereof.

5. The method of any of claims 1 to 4, wherein said antimicrobial composition further comprises a nonionic agent.

6. The method of claim 5, wherein said nonionic agent is selected from 1-(2-ethylhexyl)glycerol ether, octyl glycerol ether, 2-(2-ethylhexyloxy)propanol, octyloxy-propanol, 1-(2-ethylhexyloxy) ethanol, octyloxy ethanol, 1,2-hexylenediol, 1,2-cyclohexanedimethanol, isopropyl glycerol ether and combinations thereof.

7. The method of claim 5 or 6, wherein said nonionic agent is present in an amount of about 0.1% to about 10% by weight of total composition.

8. The method of claim 1, wherein said antimicrobial composition is applied as a wash, spray, soak, or a wipe.

9. The method of claim 1, wherein said device is a wipe, sponge, bandage, surgical drape, hospital gown, or surgical gown.

10. A method of preventing infections originating in medical devices in a patient in need thereof comprising disinfecting the devices with an effective amount of an antimicrobial composition comprising:
a. from about 0.2% to about 70% by weight of an organic acid; and b. from about 0.1% to about 40% by weight of an anionic surfactant mixture having:
i. a linear alkyl chain length of from C4 to C12 and a total head group size of at least about 4 Angstroms; and/or ii. a branched alkyl chain length of from C4 to C12; and/or iii. a branched alkyl chain length of from C4 to C12 and a total head group size of at least about 4 Angstroms;
wherein said composition is characterized by a pH of from about 2.0 to about 4.5.

11. The method of claim 10, wherein said anionic surfactant is selected from alkyl glyceryl sulfonate, alpha sulfo fatty acid, alkyl phosphonate, branched alkyl sulfonate, branched alkyl benzene sulfonate, secondary alkyl sulfate, mono ester of alkyl sulfosuccinic acid, alkyl isethionate, alkyl amidosulfonate, and combinations thereof.

12. The method of claim 10 or 11, wherein said anionic surfactant is substituted with a sulfonate, sulfate or phosphonate group.

13. The method of any of claims 10 to 12, wherein said organic acid is selected from pyroglutamic acid, adipic acid, gluconic acid, gluconolactone acid, glutamic acid, glutaric acid, glycolic acid, tartaric acid, ascorbic acid and combinations thereof.

14. The method of any of claims 10 to 13, wherein said antimicrobial composition further comprises a nonionic agent.

15. The method of claim 14, wherein said nonionic agent is selected from 1-(2-ethylhexyl)glycerol ether, octyl glycerol ether, 2-(2-ethylhexyloxy)propanol, octyloxy-propanol, 1-(2-ethylhexyloxy) ethanol, octyloxy ethanol, 1,2-hexylenediol, 1,2-cyclohexanedimethanol, isopropyl glycerol ether and combinations thereof.

16. The method of claim 14 or 15, wherein said nonionic agent is present in an amount of about 0.1 % to about 10% by weight of total composition.

17. The method of claim 10, wherein said medical device is a wipe, sponge, bandage, surgical drape, hospital gown, or surgical gown.

18. The method of claim 10, wherein said infection is caused by at least one of the following: yeast, molds, bacteria, or viruses.