Systematic review of antimicrobial treatments for diabetic foot ulcers

Nelson, E Andrea; O’Meara, Susan; Golder, Su; Dalton, Jane; Craig, Dawn; Iglesias, Cynthia P

doi:10.1111/j.1464-5491.2006.01785.x

Cited by 118 publications

(76 citation statements)

References 47 publications

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“…This amphiphilic and nonhemolytic peptide has been shown to kill bacteria by perturbing the membrane function responsible for cellular osmotic balance by selfassembling in the cell membrane to form transmembrane pores [10,11]. Human clinical trials showed that a magainin derivative, Pexiganan, was developed for the intended application to infected diabetic foot ulcers [12]. Other studies have suggested that magainin might be used for contraception [13] and treatment of cancer [14].…”

Section: Introductionmentioning

confidence: 99%

Transdermal delivery enhanced by magainin pore-forming peptide

Kim

Ludovice

Prausnitz

2007

Journal of Controlled Release

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In this study we tested the hypothesis that magainin, a peptide known to form pores in bacterial cell membranes, can increase skin permeability by disrupting stratum corneum lipid structure. We further hypothesized that magainin's enhancement requires co-administration with a surfactant chemical enhancer to increase magainin penetration into the skin. In support of these hypotheses, exposure to a known surfactant chemical enhancer, N-lauroyl sarcosine (NLS), in 50% ethanol solution increased in vitro skin permeability to fluorescein 15 fold and the combination of magainin and NLS-ethanol synergistically increased skin permeability 47 fold. In contrast, skin permeability was unaffected by exposure to magainin without co-enhancement by NLS-ethanol. Furthermore, confocal microscopy showed that magainin in the presence of NLS-ethanol penetrated deeply and extensively into stratum corneum, whereas magainin alone penetrated poorly into the skin. Additional analysis by Fouriertransform infrared spectroscopy, X-ray diffraction, and differential scanning calorimetry showed that NLS-ethanol disrupted stratum corneum lipid structure and that the combination of magainin and NLS-ethanol disrupted stratum corneum lipids even further. Altogether, these data suggest that NLSethanol increased magainin penetration into stratum corneum, which further increased stratum corneum lipid disruption and skin permeability. We believe this is the first study to demonstrate the use of a pore-forming peptide to increase skin permeability. This study also introduces the novel concept of using a first chemical enhancer to increase penetration of a second chemical enhancer into the skin to synergistically increase skin permeability to a model drug.

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Section: Introductionmentioning

confidence: 99%

Transdermal delivery enhanced by magainin pore-forming peptide

Kim

Ludovice

Prausnitz

2007

Journal of Controlled Release

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“…Enfeksiyonda lokal bulgular olan eritem, ağrı, ısı artışı ve hassasiyet, abse ve osteomiyelit varlığında saptanamayabilir. Sık karşılaşılan bir sorun olmasına rağmen, tanı ve tedavi konusunda farklı yaklaşımlar mevcuttur (4,5,6).…”

Section: Tanıunclassified

Sentinel Lymph Node Biopsy for Gastrointestinal Cancers

Birben¹,

Özkan²,

Zülfikaroğlu³

et al. 2017

Nts

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“…Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive PTB test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. [19][20][21][22][23][24][25] This clinical sign is of great importance since early reports in 1995, Grayson et al 16 who explored the possibility of osteomyelitis in wounds by the use of a sterile blunt metal probe. They concluded that the PTB test had a positive predictive value of 89%.…”

Section: -14 Days)mentioning

confidence: 99%

“…24 On the other hand, alternative modalities such as natural honey have been in use for a millennia and recently a new interest by clinicians worldwide have surfaced through the publications of case series and case studies highlighting its efficacy in various types of wounds. [25][26][27][28][29][30][31][32] This is quite important since natural honey offers an efficacious and cost effective alternative option characterized by its ability to provide moisture, antimicrobial cover and anti-inflammatory properties. 32 This is quite important especially in developing countries where diabetes has reached epidemic proportions and the incidence of diabetic wounds is likely to rise too thereby posing a huge economic burden on already stretched out economies.…”

Section: -14 Days)mentioning

confidence: 99%

Triangle of Wound Assessment Made Easy: Revisited

Mohamed¹,

Lenjawi²

2016

Dermatol Open J

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Objective : We have provided evidence based critical review of the "Triangle of wound assessment made easy". Background: Wound assessment is a vital step in managing patients with acute and chronic wounds in daily clinical practice. The natural progression of most wounds is to heal naturally in a coherent and timely manner, although a minority of wounds will fail to heal. The aim of treating recalcitrant wounds that fail to heal is to control symptoms and delay or prevent complications. One vital step in managing wounds is proper and comprehensive evidence based wound assessment. Methods: We have carried out literature review including systemic reviews, met analysis pertaining wound assessment including international guidelines. Results:We have found few gaps in the proposed "Triangle of wound assessment made easy" which have been addressed accordingly. We have revised the concept of (infection) i.e. "raised white blood cell (WBC) count as a sign of infection" and argued that in up to one-half of patients, even with severe diabetic foot infection raised temperature, WBC count, or sedimentation rate are absent. A second point of concern is the omission of "probing to bone sign" in the diagnostic criteria of local signs of infection. Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive Probe-to-Bone Test (PTB) test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. Lastly, the authors have suggested reducing wound bio burden/manage infection through the use of topical antimicrobial therapy-including antiseptic agents. Topical antiseptics have inconclusive proof of efficacy in various etiology wounds and concern remain regarding their residual cytotoxicity when in contact with newly forming granulating tissues especially when highly concentrated rinse solutions is the common practice in developing countries of the world. Conclusion: On the basis of these analysis, we propose revising the "Triangle of wound assessment made easy" in order to address these gaps and maximize its utility in clinical practice.

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Systematic review of antimicrobial treatments for diabetic foot ulcers

Abstract: The evidence is too weak to recommend any particular antimicrobial agent. Large studies are needed of the effectiveness and cost-effectiveness of antimicrobial interventions.

Cited by 118 publications

References 47 publications

Transdermal delivery enhanced by magainin pore-forming peptide

Transdermal delivery enhanced by magainin pore-forming peptide

Sentinel Lymph Node Biopsy for Gastrointestinal Cancers

Triangle of Wound Assessment Made Easy: Revisited

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