Efficacy and safety of neutral pH superoxidised solution in severe diabetic foot infections

Abstract

The use of antiseptics in wound care is often controversial and there is definitely a need for a non toxic, highly disinfective agent. This study assessed the efficacy of a neutral pH superoxidised aqueous solution (NpHSS) for infection control, odour reduction and surrounding skin and tissue damage on infected diabetic foot ulcerations. From November 2003 to March 2004, 45 patients with type 2 diabetes were randomised into a single-blind clinical trial comparing NpHSS (intervention group; n = 21) versus conventional disinfectant (control group; n = 16). All patients received comprehensive care including surgical debridement as appropriate, moist wound care, intensive glucose control and broad spectrum antibiotics. Treatment groups were matched in terms of sex, age (61.9 +/- 11.9 versus 67.8 +/- 11.6), years of diabetes duration (16.4 +/- 8.1 versus 17 +/- 10.2), obesity, HgAlc (7.1 +/- 2 versus 6.7 +/- 1.8), initial fasting glycaemia (163 +/- 59 versus 152 +/- 65.8 mg/dl), ulcer duration/week (13.7 +/- 24 versus 15.1 +/- 16.3), B/A Index (0.9 +/- 0.5 versus 1.14 +/- 0.7), depth and extent of infection/periwound cellulitis (groups B and C of the Tampico Hospital Classification) as well as aetiology (P = 0.647). Odour reduction was achieved in all NpHSS patients (100% versus 25%; P < 0.01) and surrounding cellulitis diminished (P < 0.001) in 17 patients (80.9% versus 43.7%). Nineteen patients in the NpHSS group showed advancement to granulating tissue stage (90.4% versus 62.5%; P = 0.05) with significantly less tissue toxicity (94% versus 31.2%; P < 0.01). A non toxic, NpHSS, as part of a comprehensive care regimen, may be more efficacious in infection control, odour and erythema reduction than conventional disinfectants in treatment of diabetic foot infections.

Microbiological and clinical response of superoxidized solution versus povidone iodine in the management of lower limb ulcers

“…Most of the antiseptics currently used in wound care are cytotoxic, may cause damage to the granulation tissue, interfere in the wound healing process and are far from ideal wound care products. [6] Superoxidized solution, an electrochemically processed aqueous solution with neutral pH, is a new concept in wound management. It …”

“…[14,15] Superoxidized solution, an effective non-toxic antiseptic agent, promotes rapid healing without damaging normal host tissues. [6] The mean duration of treatment in patients treated with superoxidized solution was significantly less than the patients treated with povidone iodine. This was consistent with the findings of Paola et al where the median healing time for infected diabetic foot ulcers was 43 days versus 55 days in superoxidized solution and povidone iodine groups, respectively.…”

“…[6] The patients were also evaluated for microbiological response and clinical efficacy. While complete eradication of the causative organism was seen in 97% of the ulcers treated with superoxidized solution, only 85% of the ulcers treated with povidone iodine showed complete eradication.…”

“…[2] Broad spectrum antimicrobials like povidone iodine used for initial surgical debridement for polymicrobial infections have cytotoxic effect, thus leading to tissue damage and delayed wound healing due to abnormal inflammatory response and persistent infection. [6] Further, the resultant dry, dark, indurated skin from povidone iodine applications makes it difficult to distinguish whether the delayed wound healing is secondary to infection or chemical damage. [6] Superoxidized solution, a new concept in wound management is an electrochemically processed aqueous solution with neutral pH, nontoxic, and dermal wound irrigant which is rich in reactive oxygen species and has a longer half-life (>12 months).…”

“…[6] Further, the resultant dry, dark, indurated skin from povidone iodine applications makes it difficult to distinguish whether the delayed wound healing is secondary to infection or chemical damage. [6] Superoxidized solution, a new concept in wound management is an electrochemically processed aqueous solution with neutral pH, nontoxic, and dermal wound irrigant which is rich in reactive oxygen species and has a longer half-life (>12 months). Superoxide solution is stable, non-flammable and non-corrosive that is ready to use with no further dilution or mixing.…”