0.045% DAC N-055 a choice for poor Afghan surgical patients?

Abstract

Introduction / objectives: O2 enriched pharmaceutical chlorite [NaClO2 German Drug Codex monograph DAC N-055, 1990] contains Na2Cl2°6 formerly called TCDO, (NaClO2)4 O2 fights tissue infections and promotes wound granulation of radiogenic ulcers [http://www-pub.iaea.org/mtcd/ publications/pdf/te-1300-web.pdf]. Under our hygienic conditions the intra- and postoperative topical use of 0.045% DAC N-055 helps us to deal with bone & tissue infections in orthopaedic surgery in Mazar. Here we document 4 cases out of the total number of 26 patients, we monitored in the former Military Hospital in Mazar 2004 - 2006 to familiarize ourselves with this German drug first registered as Oxoferin® in 1983. Methods: The speed of ClO2 release from 0.045% DAC N-055 (max. 160 ppm) increases with decreasing pH. ClO2 induces no resistance. In all patients the field of surgical intervention is rinsed several times with 0.045% DAC N-055 in saline especially during the operation, especially before wound closure and dressed with cotton gauzes kept moist till the patient is discharged home. Post-OP irrigations are practised with 0.045% DAC N-055 for septic arthritis (closed method) and osteomylitis (open method). Results: 1/2 septic arthritis, osteomyelitis cases and 2/22 osteomyelitis cases are photo-documented. Without antibiotics, septic arthritis had an excellent functional outcome after 6 weeks, the open fracture with skin defect received mesh graft on excellent granulation after 1 month and was completely closed after 3 months. 11/22 osteomyelitis cases could be monitored for 6 to 18 months, 6 cases relapsed within this time, for 8/11 patients antibiotics were not available. Conclusion: If 4.5% DAC N-055 could be sold in Afghanistan at 50% of the price of the finished drug Oxoferin® sold in Pakistan this could help poor patients in traumatology.