Citric acid treatment of a diabetic leg ulcer infected with meticillin-resistant Staphylococcus aureus

Diabetic leg ulcers are difficult to manage. Infection by bacterial pathogens, such as meticillin-resistant Staphylococcus aureus (MRSA), is one of the most important reasons for non-healing of ulcers. If not treated in a timely manner, the ulceration may progress to septicaemia, amputation and even death. We report a successful treatment of a diabetic leg ulcer infected with MRSA, which was not responding to conventional antibiotic therapy and local wound care combined, with a local application of 3% citric acid ointment once daily for 30 days. The results indicated that its use may be a potential treatment in the management of hard-to-heal ulcers when all other options have been exhausted.

Using Topical Citric Acid to Treat an Infected Ulcerated Hemangioma in an Infant: A Case Study

Infantile hemangiomas (IHs) are the most common vascular abnormalities in children under 1 year old; most IHs involute spontaneously and do not need intervention unless a complication occurs. Ulceration and secondary infection are the most common complications. Despite appropriate conventional wound care, ulcerated IHs are difficult to heal. Although oral propranolol and topical timolol have been found to be effective in the treatment of ulcerated hemangiomas, they have been reported to have adverse effects and limitations. Citric acid has been used on pediatric patients without any reported adverse effects in the treatment of a variety of infected wounds refractory to conventional treatment modalities. Herein, the authors report the case of a large, ulcerated, infected hemangioma treated with topical application of citric acid ointment.  Case Report. A 6-month-old otherwise healthy infant who had undergone previous, unsuccessful treatment of a large, ulcerated hemangioma infected with Pseudomonas aeruginosa was treated using topical application of 3% citric acid in a petroleum jelly base once daily for 24 days. Topical application of citric acid resulted in complete healing of the ulcer in 24 applications. Conclusions. The efficacy, ease of application, and absence of notable adverse effects of using citric acid suggest it may be an effective option for the treatment of hemangiomas in children.

Citric acid treatment of oral ulcers refractory to conventional treatment: a case study

OBJECTIVE

Oral ulcers are painful sores that appear in the mouth. Most of them are usually harmless and clear up on their own. Sometimes, they are non-responsive and difficult to manage. This report describes the case of an 80-year-old female patient with chronic oral ulcers of three years duration and which were refractory to conventional therapy. The ulcers were subsequently treated using 3% citric acid as a sole topical agent, applied three times a day that resulted in complete healing of oral ulcers by day 10 of treatment. The findings of this case report suggest that topical citric acid is a possible alternative treatment for chronic oral ulcers unresponsive to conventional treatment.

Studies on wound healing potential of topical herbal formulations- do we need to strengthen study protocol?

Healing of wound is a normal biological process that occurs naturally as long as it is not obstructed by infection. Many monoherbal and polyherbal formulations have been reported to hasten/accelerate wound healing activity in freshly prepared incisional and excisional experimental wound models. In the present review, an attempt has been made to throw light on importance of microbial infection in the process of wound healing and antimicrobial activity of herbal formulations. Different herbal formulations have been reported to hasten/accelerate the process of wound healing by enhancing epitheliazation, neovascularization, formation of granulation tissue, collagen synthesis, wound contraction, tensile strength, etc. As these studies have been conducted in freshly prepared non-infected wounds, it is difficult to ascertain the wound healing potential of these formulations in absence of microbial colonization/infection and results are not justifiable because the healing is limited to non-infected wounds. It would be more appropriate to ascertain the wound healing potential and not hastening/accelerating the wound healing property of newer herbal formulations on wound healing in experimental animals in presence of colonization/infection. Hence, it is recommended to strengthen these study protocols further using suitable controls to find out the antimicrobial activities of herbal formulations and their effect on wounds colonized/infected with pathogenic microbes in significant numbers to achieve more meaningful and concrete conclusions.

Profile and Antibiotic Susceptibility of Bacterial Pathogens Associated With Diabetic Foot Ulcers From a Rural Area

OBJECTIVE

This cross-sectional study assesses the profile and antibiotic susceptibility of aerobic bacterial pathogens associated with diabetic foot ulcers (DFUs).

MATERIALS AND METHODS

Two swab samples from 140 DFUs with various Wagner grades were processed for identification using routine culture methods and antimicrobial susceptibility by Kirby-Bauer disc diffusion method.

RESULTS

A total of 125 (89.29%) samples were found to be positive for bacteria on culture. A higher incidence of positive culture (94.32%) was found in individuals with a blood sugar level > 200 mg/dL. The highest number of culture-positive cases was observed in Wagner grade 2 DFUs (45%). Overall infection was monomicrobial in 83.20% (104) and polymicrobial in 16.80% (21) of samples. Staphylococcus aureus (21.09%) and Pseudomonas aeruginosa (19.05%) were the most common isolates. Linezolid (100%) and imipenem (75.70%) were the most effective antimicrobial agents against gram-positive and gram-negative isolates, respectively.

CONCLUSIONS

The results show an overall increase in bacterial resistance to antimicrobial agents and emphasize the importance of an antimicrobial susceptibility pattern in the selection of appropriate antibiotic(s) to institute the rational antibiotic therapy.