Reactive oxygen therapy: a novel therapy in soft tissue infection

The global burden of disease in skin and soft tissue lesions is enormous. Many chronic, poorly healing lesions get treated with antibiotics despite the lack of evidence for long-term antibiotics. There is a global antibiotic resistance crisis driven largely by inappropriate use of large volumes of antibiotics. One solution is to reduce the selection pressure on bacteria by reducing the volume of antibiotic use in medicine, agriculture and the environment. There are few novel antimicrobials. One of the only novel agents to reach clinical use is one using reactive oxygen species (ROS), oxygen radicals, as an antimicrobial mechanism.

ROS can be delivered to the site of infection in various formats. ROS is highly antimicrobial against Gram-positive and negative bacteria, viruses and fungi. It also prevents and breaks down biofilm. These functions make ROS highly suitable for chronic inflammatory conditions, where antibiotics are frequently overused and relatively ineffective: chronic wounds, ulcers and burns; but also possibly mucosal infections in the respiratory and urinary tracts and in prosthetic device infection. ROS could also have an important role in infection prevention and antimicrobial stewardship.

Early clinical data support ROS treatment in skin and soft tissue lesions to reduce bacterial bioburden and biofilm in critical colonization and in preventing surgical site infection, although further trials of ROS in soft tissue infection would be helpful and research in ROS use at other clinical sites might support many novel clinical indications.