A novel sustained-release matrix based on biodegradable poly(ester amide)s and impregnated with bacteriophages and an antibiotic shows promise in management of infected venous stasis ulcers and other poorly healing wounds.
Healing of poorly vascularized and venous stasis ulcers is often refractory to therapy, particularly when they are infected. Systemic antibiotic therapy may be of little benefit in this setting because of poor penetration of the antibiotic into the wound and the frequent associated emergence of bacterial strains resistant to common antimicrobial agents. Given the clinical significance of these problems, there is a need to explore alternative management approaches for these difficult-to-treat wounds. PhagoBioDerm is a novel wound-healing preparation consisting of a biodegradable polymer impregnated with an antibiotic and lytic bacteriophages, which was recently licensed for sale in the Republic of Georgia (one of the former Soviet Union republics). In 1999-2000, in Tbilisi, Georgia, 107 patients who had ulcers that had failed to respond to conventional therapy were treated with PhagoBioDerm alone or in combination with other interventions. The wounds/ulcers healed completely in 67 (70%) of 96 patients for whom follow-up data were available. In 22 cases in which microbiologic data were available, healing was associated with the concomitant elimination of, or a reduction in, specific pathogenic bacteria in the ulcers. Our findings suggest that this slow-release biopolymer is safe and of possible benefit in the management of refractory wounds, and they support the apparent utility of bacteriophages in this setting. Further studies, including carefully designed clinical trials, will be required to rigorously evaluate the efficacy of this novel wound dressing preparation.
Vascular Outpatient Clinic "League", and Center for Medical Polymers and Biomaterials, Georgian Technical University, Tbilisi, Georgia 380077.
Kalistrat
K
Markoishvili
George
G
Tsitlanadze
Ramaz
R
Katsarava
J Glenn
JG
Morris
Alexander
A
Sulakvelidze
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001435:Bacteriophages; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000008:administration & dosage* / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000008:administration & dosage* / Q000627:therapeutic use*; D012189:Retrospective Studies; D014647:Varicose Ulcer / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology; D014946:Wound Infection / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology
D000577:Amides; D000890:Anti-Infective Agents; D001672:Biocompatible Materials; D003692:Delayed-Action Preparations; D011091:Polyesters; D002939:Ciprofloxacin