Evaluation of granulocyte-colony stimulating factor (Filgrastim) in infected diabetic foot ulcers

Abstract

Aims/hypothesis. To re-evaluate the use of Granulocyte-Colony Stimulating Factor (G-CSF) in the treatment of infected diabetic foot ulcers. Methods. Thirty-seven diabetic subjects were randomised to Granulocyte-Colony Stimulating Factor (G-CSF) (n=20) or placebo (n=17). The primary endpoint was resolution of cellulitis, which was evaluated clinically and with an infection summary score. Patients were hospitalised for 10 days and received subcutaneously either 5 µg/kg G-CSF or placebo daily. Ulcers were treated with a standard wound protocol and the patients were instructed to stay in bed. All subjects received antibiotics (clindamycin and ciprofloxacin) intravenously until the inflammation had subsided.

Diagnosing and treating diabetic foot infections

“…Four prospective, comparative, and randomized studies using G-CSF as an adjunctive therapy to standard treatment of diabetic foot infection have been published to date [84][85][86][87] (see Table 4). Overall, in 147 nonneutropenic diabetic patients evaluated, 75 received G-CSF.…”

Diagnosis and Treatment of Diabetic Foot Infections

“…Two adjunctive modalities do deserve brief comments. First, granulocyte colony-stimulating factors (G-CSFs) have now been investigated in 5 randomized trials involving diabetic foot infections [223][224][225][226][227]. A preliminary meta-analysis of these trials suggests that G-CSF does not accelerate resolution of infection but may significantly reduce the need for operative procedures (B-I) [228].…”

Inflammatory and Angiogenic Abnormalities in Diabetic Wound Healing: Role of Neuropeptides and Therapeutic Perspectives

“…Nevertheless, administration of growth factors has been shown to promote healing by affecting all phases of wound healing. Several growth factors have been studied for the promotion of diabetic wound healing, such as FGF [177][178][179], VEGF [48,82], granulocyte colonystimulating factor [180][181][182], and hepatocyte growth factor [175,[183][184][185][186][187]. Despite high expectations in laboratory models of wound healing, growth factor delivery has shown to have a limited clinical success.…”