Role of topical cholecalciferol granules for antimicrobial drug delivery in diabetic foot ulcers

Abstract

Diabetic mellitus, a metabolic disorder, has a high incidence and morbidity. Of all complications, diabetic foot ulcer is one of the commonest with 25% likelihood of a diabetic to develop diabetic for ulcers. Infection in a diabetic foot ulcer is a dreaded complication with often complicates the clinical course of the patient and is managed by local and systemic antibiotics. Local antibiotics are generally deemed ineffective in various studies due to lack of an appropriate drug delivery system. The Vit D level is inversely related to development of diabetic vascular disease. A novel strategy for treating diabetic foot ulcer with osteomyelitis may be using topical antibiotics with drug delivery system which will have minimum systemic side effects. Our case, a middle age male, having right foot diabetic ulcer with (Wagner stage 2) uncontrolled sugar levels. A trial of topical antibiotic therapy with tobramycin using cholecalciferol granules as a drug delivery system was given. Regular dressing was continued and serial wound cultures were taken. The wound culture was became sterile after 4 application of the therapy (14 days) with cholecalciferol granules with healthy granulation. The wound was fit for reconstruction after 5 applications. This report is an attempt to bring to the notice that such a drug delivery system is efficacious and may be validated using a larger trial.

Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies

“…85,86 Shekhar and colleagues published a case report in which the intervention of topical Vitamin D 3 granules improved the wound healing in a DFU patient following five applications. 297 A similar observational study conducted by the same researcher including 10 diabetic patients with open infected wounds showed promising outcomes as well. 298 The effects of Vitamin C on wound healing include promoting collagen synthesis, modulating immune function, and acting as antioxidant.…”

“…Several RCTs demonstrated the positive effect of oral vitamin D on diabetic wound healing (Wagner grade 1 to 3) with improved metabolic parameters, inflammatory and oxidative stress biomarkers 85,86 . Shekhar and colleagues published a case report in which the intervention of topical Vitamin D 3 granules improved the wound healing in a DFU patient following five applications 297 . A similar observational study conducted by the same researcher including 10 diabetic patients with open infected wounds showed promising outcomes as well 298 …”