Evaluation of ozonated oxygen in an experimental animal model of osteomyelitis as a further treatment option for skull-base osteomyelitis

Abstract

The standard treatment of chromic skull-base osteomyelitis is antibiotics and surgical removal of sequestrums. Hyperbaric oxygen therapy has been found to be a useful method for managing refractory cases of chronic osteomyelitis. Since a minimal blood supply is needed for hyperbaric oxygen therapy, chronic osteomyelitis can produce necrotic infected areas that are not nutrified and therefore not assessable for hyperbaric oxygen therapy. Ozone is known to be an oxidizing medium with a strong bactericidal effect. We investigated the influence of locally applied ozonated oxygen on the development of chronic osteomyelitis in an experimental animal model using the femur of the rabbit. The proximal sides of the femurs of 40 rabbits were prepared and a needle inserted into the intramedullary cavity. Osteomyelitis was induced with an infusion of Staphylococcus aureus and sodium morrhuate into the bone. The needle was left in a intramedular location. After a 4-week delay animals were randomly separated into treatment and control groups. The infected femur of treated animals was flushed three times a day with 20 ml of ozonated oxygen at an ozone concentration of 107 micrograms/ml O2 over periods of 2 or 4 weeks. Clinical, radiographic and microbiological findings were documented. Chronic osteomyelitis occurred in all animals. Ten rabbits were excluded from further study during the investigation because of excessive weight loss (> 15% of the original weight). Bacterial cultures showed no significant reduction of S. aureus concentrations in the ozone-treated group, although comparison of radiographic results revealed less serious osteomyelitis-related bone damage in these animals (P < 0.01). These findings indicate that refractory osteomyelitis in the head and neck may benefit from locally applied "flush" therapy with ozonated oxygen in addition to treatment with antibiotics, surgery and hyperbaric oxygen.

&lt;i&gt;In Vitro&lt;/i&gt; Evaluation of Ozone Activity on Recent Clinically Isolated Bacterial Strains

“…Thus, we confirmed the correlation between ozone bactericidal activity and membrane permeability, which is specific for each microorganism [39]. The results of our study on whole blood represents an important confirmation of the ozone bactericidal activity in the topical treatment of wounds, and the daily persistence of topical ozone preparations kills even the most resistant bacteria [25,41].…”

“…The treatment of Bacillus subtilis spores with various oxidizing agents (including ozone) damages the inner membrane, making the spores more sensitive to subsequent thermal and osmotic stresses, with the increased rapid penetration of methylamine within the core [20]. The literature also confirms the synergic action of ozone with antibiotic therapy in vivo [21][22][23][24][25][26].…”

Evaluation and Comparison of the Effects of Hyperbaric Oxygen and Ozonized Oxygen as Adjuvant Treatments in an Experimental Osteomyelitis Model

“…Yamayoshi and Tatsumi reported that even resistant strains of S. aureus are sensitive to O 3 [36]. Steinhart et al [13] used clinical radiologic and microbiologic analyses and found that locally applied ''flush'' O 3 therapy along with antibiotic treatment and surgery were useful for osteomyelitis in the head and neck. Some studies indicated that O 3 in very high concentrations was an excellent agent to kill viruses (e.g., HIV) and bacteria in plasma ex vivo, indicating a possible use in vivo [37][38][39] Burgassi et al [40] however, reported that O 3 and the cascade of its derivative products are potent bactericidal agents, but even small amounts of human plasma in bacterial suspensions inhibit oxidation and protect bacteria.…”

“…Ozonized O 2 or ozonized air is used to disinfect drinking water and instruments because of its bactericidal effects [12]. Also, O 3 was applied locally for experimental bone model infection in the skull base as a further treatment option [13].…”

How much ozone bactericidal activity is compromised by plasma components?

“…Abscesses, anal fissures bed sores, fistulae, furunculosis, chronic osteomyelitis, peritonitis, vulvovaginitis and other chronic infections have been shown to improve rapidly because the ozonated solutions display a cleansing effect and act as a potent disinfectant able to kill antibiotic-resistant or anaerobic bacteria (Steinhart et al 1999;Nagayoshi et al 2004;Bocci 1999Bocci , 2006. Moreover, the release of oxygen improves the tissue metabolism and some chemical compounds generated by the reaction of ozone with biomolecules present in the exudate, stimulate cell proliferation and healing.…”