netilmicin and Diabetes-Mellitus--Type-2

Since systemic treatment of neuropathic plantar ulcers in diabetics (DNPU) has so far been rather ineffective, recent reports of successful management of DNPU by short-term retrograde transvenous leg perfusion (RVP) by South American angiologists encouraged us to apply this treatment method in diabetics suffering from chronic DNPU. Hence, in a prospective comparative clinical trial started in 1989 we have treated 45 male diabetics suffering from DNPU with the same daily doses of netilmycin, administered either in systemic venous infusions (SVI: n = 21, three times/day) or in RVP (n = 24, once/day). After 10 consecutive days of treatment, ulcers had closed in 8 of the 24 patients treated with RVP, as against 3 of the 21 treated with SVI. Diminution of the ulcer area by > 30% including full debridement was achieved in 10/24 of the RVP cases (SVI: 4/21). During 6 months of follow-up, amputation of toes or forefoot was necessary in only 1 patient in the RVP group, but in 4 in the SVI group. Partial restitution of osteolytic damage was observed in some cases after RVP. Our results show that regional netilmycin therapy given by the RVP procedure is clearly superior to equal netilmycin doses administered by SVI for the treatment of DNPU. RVP can be recommended in DNPU, particularly when the ulcers are complicated by infections.

Topics: Adult; Aged; Chemotherapy, Cancer, Regional Perfusion; Combined Modality Therapy; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Dose-Response Relationship, Drug; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Middle Aged; Netilmicin; Prospective Studies; Wound Healing; Wound Infection

The ulcero-mutilating neuropathy is defined by the triad of painless ulcers of the feet, sensitive polyneuropathy of the lower legs and osteolysis in the forefoot area. The condition mainly affects middle-aged men suffering from diabetes mellitus, liver diseases, alcoholism, obesity and constitutional foot deformities. Systemic venous infusions of appropriate antibiotics can hardly reach effective target tissue levels because of the damaged microcirculation. Thus we used retrograde venous perfusion (RVP) of several drugs into the injured leg during short time blockade of arterial blood supply and achieved better therapeutic effects. Applying the RVP route, a solution containing 200 mg netilmycin, 120 mg gentamycin, 50 mg buflomedil, 2500 IU heparin and 4 mg dexamethasone in 100 ml 0.9% saline was injected as bolus into a dorsal foot vein and the blood supply was blocked for 20 minutes. The RVP was carried out daily over a period of 7 to 10 days. We treated 7 patients suffering from a ulcero-mutilating neuropathy with the RVP. Over an observation period of up to four weeks, in one patient the plantar ulcers healed completely, while in the other six cases the RVP lead to a regression of inflammatory signs and a reduction of ulcer size of up to 50 per cent.

Topics: Alcoholism; Anti-Inflammatory Agents; Anticoagulants; Dexamethasone; Diabetes Complications; Diabetes Mellitus, Type 2; Diabetic Foot; Diabetic Neuropathies; Fibrinolytic Agents; Follow-Up Studies; Foot Ulcer; Gentamicins; Heparin; Humans; Leg; Male; Middle Aged; Netilmicin; Osteolysis; Perfusion; Pharmaceutical Preparations; Platelet Aggregation Inhibitors; Polyneuropathies; Pyrrolidines; Risk Factors; Syndrome; Terminology as Topic; Time Factors; Vasodilator Agents