Role of an Acidic Environment in the Treatment of Diabetic Foot Infections: A Review

Overview

Journal World J Diabetes

Publisher Baishideng Publishing Group

Specialty Endocrinology

Date 2021 Oct 11

PMID 34630906

Citations 7

Authors

Basavraj Nagoba

Ajay Gavkare

Abhijit Rayate

Sachin Mumbre

Arunkumar Rao

Basavraj Warad

Neeta Nanaware

Nawab Jamadar

Affiliations

Soon will be listed here.

Abstract

Management of diabetic foot ulcers is the biggest challenge to the clinician, as conventional antibiotic therapies and local wound care have their own limitations. They are not effective for control of infections and promotion of healing because of cytotoxic effects. In view of cytotoxicity of routinely used topical antiseptic agents, this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process. This review focuses on the use of various acids such as citric, acetic, hyaluronic, and hypochlorous acids as topical agents in diabetic foot infections. This article also focuses on the different roles of acids in the treatment of diabetic foot infections.

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References

DAKIN H . THE ANTISEPTIC ACTION OF HYPOCHLORITES: The Ancient History of the "New Antiseptic.". Br Med J. 2010; 2(2866):809-10. PMC: 2303451. DOI: 10.1136/bmj.2.2866.809. View

Sloss J, Cumberland N, Milner S . Acetic acid used for the elimination of Pseudomonas aeruginosa from burn and soft tissue wounds. J R Army Med Corps. 1993; 139(2):49-51. DOI: 10.1136/jramc-139-02-04. View

Tandon S, Singh B, Kapoor S, Mangal S . Comparison of Effect of pH Modulation on Wound Healing with Topical Application of Citric Acid Versus Superoxide Ions. Niger J Surg. 2020; 26(2):122-126. PMC: 7659760. DOI: 10.4103/njs.NJS_14_19. View

Viswanathan V, Narayan Rao V . Managing diabetic foot infection in India. Int J Low Extrem Wounds. 2013; 12(2):158-66. DOI: 10.1177/1534734613486153. View

Nagoba B, Selkar S, Wadher B, Gandhi R . Acetic acid treatment of pseudomonal wound infections--a review. J Infect Public Health. 2013; 6(6):410-5. DOI: 10.1016/j.jiph.2013.05.005. View

Richard J, Sotto A, Lavigne J . New insights in diabetic foot infection. World J Diabetes. 2011; 2(2):24-32. PMC: 3083903. DOI: 10.4239/wjd.v2.i2.24. View

Nagoba B, Gandhi R, Wadher B, Gandhi S, Selkar S . Citric acid treatment of necrotizing fasciitis: a report of two cases. Int Wound J. 2010; 7(6):536-8. PMC: 7951580. DOI: 10.1111/j.1742-481X.2010.00721.x. View

Mah T, OToole G . Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol. 2001; 9(1):34-9. DOI: 10.1016/s0966-842x(00)01913-2. View

Kozol R, Gillies C, Elgebaly S . Effects of sodium hypochlorite (Dakin's solution) on cells of the wound module. Arch Surg. 1988; 123(4):420-3. DOI: 10.1001/archsurg.1988.01400280026004. View

10.

Banu A, Noorul Hassan M, Rajkumar J, Srinivasa S . Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study. Australas Med J. 2015; 8(9):280-5. PMC: 4592943. DOI: 10.4066/AMJ.2015.2422. View

11.

Kvam B, Fragonas E, Degrassi A, Kvam C, Matulova M, Pollesello P . Oxygen-derived free radical (ODFR) action on hyaluronan (HA), on two HA ester derivatives, and on the metabolism of articular chondrocytes. Exp Cell Res. 1995; 218(1):79-86. DOI: 10.1006/excr.1995.1133. View

12.

Bansal E, Garg A, Bhatia S, Attri A, Chander J . Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008; 51(2):204-8. DOI: 10.4103/0377-4929.41685. View

13.

Agrawal K, Sarda A, Shrotriya R, Bachhav M, Puri V, Nataraj G . Acetic acid dressings: Finding the Holy Grail for infected wound management. Indian J Plast Surg. 2018; 50(3):273-280. PMC: 5868106. DOI: 10.4103/ijps.IJPS_245_16. View

14.

Knighton D, Halliday B, Hunt T . Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg. 1986; 121(2):191-5. DOI: 10.1001/archsurg.1986.01400020077009. View

15.

Chen C, Hung W, Lin S . Effectiveness of hyaluronic acid for treating diabetic foot: a systematic review and meta-analysis. Dermatol Ther. 2014; 27(6):331-6. DOI: 10.1111/dth.12153. View

16.

Nagoba B, Gandhi R, Wadher B, Potekar R, Kolhe S . Microbiological, histopathological and clinical changes in chronic infected wounds after citric acid treatment. J Med Microbiol. 2008; 57(Pt 5):681-682. DOI: 10.1099/jmm.0.47647-0. View

17.

Frenkel J . The role of hyaluronan in wound healing. Int Wound J. 2012; 11(2):159-63. PMC: 7950635. DOI: 10.1111/j.1742-481X.2012.01057.x. View

18.

Hunt T, Hopf H . Wound healing and wound infection. What surgeons and anesthesiologists can do. Surg Clin North Am. 1997; 77(3):587-606. DOI: 10.1016/s0039-6109(05)70570-3. View

19.

Nagoba B, Patil Dawale C, Raju R, Wadher B, Chidrawar S, Selkar S . Citric acid treatment of post operative wound infections in HIV/AIDS patients. J Tissue Viability. 2014; 23(1):24-8. DOI: 10.1016/j.jtv.2013.12.004. View

20.

Chen W, Abatangelo G . Functions of hyaluronan in wound repair. Wound Repair Regen. 1999; 7(2):79-89. DOI: 10.1046/j.1524-475x.1999.00079.x. View