title: Treatment of osteomyelitis in the feet of diabetic patients by photodynamic antimicrobial chemotherapy.
abstract: OBJECTIVE
  This article describes two inexpensive photodynamic antimicrobial chemotherapy (PACT) protocols to provide intensive local care on ulcerated feet of diabetic patients with osteomyelitis.
  
  
  BACKGROUND
  Patients with this condition generally have poor quality of life. The usual treatment consists of the administration of a cocktail of drugs including anti-inflammatories, promoters of blood circulation, and systemic antibiotics. However, depending on the conditions of the tissues, amputation may be required. Consequently, it is important to develop PACT protocols that can help avoid amputation.
  
  
  METHODS
  Two PACT protocols were applied to two diabetic patients with osteomyelitis. These protocols were based on several PACT sessions that consisted of: (1) local injection of mixtures of phenothiazines (2% in water) and Hypericum perforatum extract (10% in propylene glycol), and (2) illumination, lasting 10 min, applied to the lesion's interior and exterior using, respectively, an optical fiber and a non-coherent light source. The frequency of PACT was daily or every other day in the beginning, and weekly after tissue recovery begun. The patients were followed clinically and by radiographic testing.
  
  
  RESULTS
  Both PACT protocols helped cure these patients who were about to have amputation of their feet. Radiograms showed that bone had healed and that the bone's texture had improved.
  
  
  CONCLUSIONS
  Here we have described efficient and affordable PACT protocols to treat osteomyelitis in the feet of diabetic patients. This treatment modality should be considered by vascular surgeons and by orthopedists to treat osteomyelitis that is resistant to conventional treatments.
authors.affiliation: CEDERM-UNIFESP e Centro Médico Laser, Instituto de Química da USP, São Paulo, SP, Brazil.
authors.forename: João P
authors.initials: JP
authors.lastname: Tardivo
authors.forename: Mauricio S
authors.initials: MS
authors.lastname: Baptista
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017719:Diabetic Foot / Q000150:complications*; D006214:Hallux; D006801:Humans; D020902:Hypericum; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy*; D010640:Phenothiazines / Q000008:administration & dosage; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage; D008517:Phytotherapy; D028321:Plant Preparations; D050277:Toe Phalanges
chemical_list: D000900:Anti-Bacterial Agents; D010640:Phenothiazines; D017319:Photosensitizing Agents; D028321:Plant Preparations