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I have not personally used vineagar/Acetic Acid on wounds, but have closely watched a Doctors dressing regime, on two seperate clients over a 4-6 week period. Both had heavy growths of pseudomonas, and seemed to respond well to the Vinegar/Acetic Acid.
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Hippocrates in the 5th century BC used vinegar or acetic acid as a wound antiseptic. As a 0.25% to 0.5% solution, it is bactericidal against many Gram-positive and Gram-negative organisms, and is effective in reducing bacterial burden. By convention, it is a popular adjunctive short-term treatment for superficial wound infections with Pseudomonas aeruginosa. Since Pseudomonas spp typically develop quick resistance to many topical and systemic agents, this simple approach, which reduces local pH, can reduce the bacterial burden of this microorganism in the wound. Diluted vinegar soaks for 15 minutes per day are effective and reduce problems of local wound odor if a mixed aerobic-anaerobic flora is present. This approach is effective for critically colonized wounds in the superficial compartment. In a venous leg ulcer study, gauze dressings wetted with acetic acid decreased the number of S aureus isolates and Gram-negative rods.24 Although some in-vitro studies have suggested that acetic acid is cytotoxic, these findings have not borne out in the in-vivo arena using conventional treatment doses.
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3.4.2.7 Chemical stress
Iodine, peroxide, chlorhexidine, alcohols, hypochlorites and acetic acid are commonly used
antiseptics and cleansing agents. Use of these agents is often responsible for delayed healing, since they are non-selective in their activity and will kill healthy cells as well as bacteria. It is preferable to avoid the prolonged use of these products on a granulating wound. Even their use in infected wounds is somewhat dubious, as research has shown that although they may reduce the surface load of bacteria in an infected wound, they do not penetrate below the surface and therefore have no real effect on the infection in the tissue itself. They may be of use in dilute forms when applied to some chronic wounds and left in place for no more than five minutes and then washed off. http://www.dva.gov.au/service_provid...s/wdcaremd.pdf
3.4.2.7 Chemical stress
Iodine, peroxide, chlorhexidine, alcohols, hypochlorites and acetic acid are commonly used
antiseptics and cleansing agents. Use of these agents is often responsible for delayed healing, since they are non-selective in their activity and will kill healthy cells as well as bacteria. It is preferable to avoid the prolonged use of these products on a granulating wound. Even their use in infected wounds is somewhat dubious, as research has shown that although they may reduce the surface load of bacteria in an infected wound, they do not penetrate below the surface and therefore have no real effect on the infection in the tissue itself. They may be of use in dilute forms when applied to some chronic wounds and left in place for no more than five minutes and then washed off. http://www.dva.gov.au/service_provid...s/wdcaremd.pdf
Quote:
Originally Posted by grosit01
????Acetic acid maybe of use????
No, that is not what your source is suggesting at all (See bold and underlined).
Quote:
Originally Posted by grosit01
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Hippocrates in the 5th century BC used vinegar or acetic acid as a wound antiseptic. As a 0.25% to 0.5% solution, it is bactericidal against many Gram-positive and Gram-negative organisms, and is effective in reducing bacterial burden. By convention, it is a popular adjunctive short-term treatment for superficial wound infections with Pseudomonas aeruginosa. Since Pseudomonas spp typically develop quick resistance to many topical and systemic agents, this simple approach, which reduces local pH, can reduce the bacterial burden of this microorganism in the wound. Diluted vinegar soaks for 15 minutes per day are effective and reduce problems of local wound odor if a mixed aerobic-anaerobic flora is present. This approach is effective for critically colonized wounds in the superficial compartment. In a venous leg ulcer study, gauze dressings wetted with acetic acid decreased the number of S aureus isolates and Gram-negative rods.24 Although some in-vitro studies have suggested that acetic acid is cytotoxic, these findings have not borne out in the in-vivo arena using conventional treatment doses.
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Acetic acid produced the strongest cytotoxic effect.........testing the cytotoxicity of organic acids on mammalian cells is usefull in preventing the detrimental effects of organic acids to the mammalian cells before using them as antibacterial agents.
.... acetic acid (0.25%) all showed statistically significant (P < 0.01) decreases in keratinocyte growth rates...
So, whilst acetic acid may be anti-microbial, from just 2 of many studies we see that acetic acid is also cytotoxic to wounds, killing proliferating fibroblasts and keratinocytes, both of which are critical to wound healing.
Why would you opt for an unproven treatment in terms of detrimental effects over others that have undergone rigorous clinical trials to determine efficacy and more importantly, safety?
I'm raising the question, not as a first option treatment, but for chronic/difficult wounds, eg significant PVD where topical treatments are needed to reduce the bacterial burden.
Im not baseing anything on that document, but that is An Australian Federal Government Document of the DVA stateing that it maybe of use.
Australian wound association also describes its use with care.
I'm interested in peoples clinical experiences???
I have asked 2 GP's, a Vascular Surgeon and a Pod from a Multi-D High Risk Foot clinic who all supported and have used Acetic Acid under certain circumstances.
Acetic acid used for the elimination of Pseudomonas aeruginosa from burn and soft tissue wounds.
Sloss JM, Cumberland N, Milner SM.
Source
Department of Pathology, Queen Elizabeth Military Hospital Woolwich, London.
Abstract
Acetic acid was used topically at concentrations of between 0.5% and 5% to eliminate Pseudomonas aeruginosa from the burn wounds or soft tissue wounds of 16 patients. In-vitro studies indicated the susceptibility of P. aeruginosa to acetic acid; all strains exhibited a minimum inhibitory concentration of 2 per cent. P. aeruginosa was eliminated from the wounds of 14 of the 16 patients within two weeks of treatment. Acetic acid was shown to be an inexpensive and efficient agent for the elimination of P. aeruginosa from burn and soft tissue wounds.
Thanks for the sources grosit. They're interesting.
Wound care is a slippery topic. I'm not aware of convincing evidence for any topical antibacterial dressing. I tend to find clinicians personal experiences with dressings more misleading than enlightening.
How have you observed vinegar being used? Was it diluted? Was it sterile? Where was it purchased from? Was it intended for medical use? Is it possible the wounds healed despite vinegar being used and not because of it? Do you use peroxide, chlorhexidine, alcohols or hypochlorites on wounds?
I participate in an Ulcer clinic two's day a week, usually seeing 5-8 wounds in a session.
I wouldnt use Acetic Acid as a dressing persay, rather question its use to cleanse a wound that has swabbed +ve to Pseudo, and due to limited perfusion/diabetes/smoking etc hasn't responded well to tradition interventions.
My war chest currently consists of Chlorhex, POVI2, NaCl, Inadine, Iodosorb, Intrasite, Intrasite Comformable, Aquacel Ag, Acticoat 7, Medihoney etc for primary dressing.
The Vinegar/Acetic Acid I've seen used was a Pharmacy preperation labelled 5%. And these were ongoing chronic wounds, one was nice and green and the GP didnt want to repeat Ciprofloxacin, I'm not sure for what reason???
I've also been told of a Plastic Surgeon using it on an infected skin graft that didnt take???
Treatment of superficial pseudomonal infections with citric acid: an effective and economical approach
B.S. Nagobaa, , S.R. Deshmukha, B.J. Wadher∗, L. Mahabaleshwar†, R.C. Gandhi†, P.B. Kulkarni†, V.A. Mane†, J.S. Deshmukh†
a Department of Microbiology, M.I.M.S.R. Medical College, Latur, India
† Department of Surgery, M.I.M.S.R. Medical College, Latur, India
∗ Medical Microbiology Research Laboratory, Department of Microbiology, Nagpur University, Nagpur, India
Received 10 September 1997. Accepted 28 April 1998. Available online 18 May 2004.
Abstract
The antibacterial effect of citric acid for antibiotic resistant Pseudomonas aeruginosa was studied. Twenty-five clinical isolates were tested and all were inhibited by 2% citric acid in a broth dilution assay. Topical application of 2–3% citric acid to wounds, for three to seven times, successfully eliminated P. aeruginosa from the site. The use of this agent is therefore recommended as an effective and economical approach to the control of multiple antibiotic resistant strains of P. aeruginosa causing superficial infections.
Maharashtra Institute of Medical Sciences and Research, Medical College and Hospital, Departments of Microbiology1, Surgery3 and Pharmacology4, Latur, Medical Microbiology Research Lab. Napur University, Nagpur2, India
Aim: Pseudomonas aeruginosa is a classic opportunistic pathogen with innate resistance to many antibiotics and disinfectants. It is ubiquitous in hospital environment and because of its ability to survive in hospital environment it creates threat to patient’s care.The antibacterial effect of acetic acid against multiple antibiotic resistant strains of Pseudomonas aeruginosa isolated from nosocomial wound infection cases was studied.
Methods: For this study, seven hospitalized patients with wound infections, not responding to traditional therapy for more than 10 days, were selected. A specimen of pus was collected before application of acetic acid and after completion of treatment (only one reculture was done) and processed for culture study. Seven clinical isolates of P. aeruginosa were studied for in vitro susceptibility to acetic acid and all were found to be inhibited by 3 % acetic acid.
Results: The pus culture yielded isolation of P. aeruginosa in all seven cases under study. No other bacterium was isolated from these cases; hence they were labeled as pseudomonal wound infections. All isolates were found to be resistant to four or more antibacterial agents but all of them were found to be inhibited by 3% acetic acid in vitro when exposed for 15 minutes or more. Topical application of 3 to 5% acetic acid to wounds for 2 to 12 times successfully eliminated P. aeruginosa from wounds.
Conclusion: The use of acetic acid is therefore recommended for effective elimination of multiple antibiotic resistant strains of P. aeruginosa from infection site.
Anyone using Vinegar on wounds, pseudomonas infections etc????
I've had some good results, just wondering what other peoples experiences were???
I regularly use vinegar to control pseudomonus infection on wound specially with renal failure patients where u cant use the aminoglycosides to control pseudomonus infection.
DR. Wadud
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A name, as opposed to a handle or pseudonym, would command more respect and replies from the podiatric community. Whilst an appreciation for the necessity of anonymity is warranted in certain circumstances, experience has indicated it is also open to abuse.
It would also be beneficial, for yourself, to state where you are practising and in which capacity. Clinical governance, that is the standard transparency, responsibility and accountability of podiatric treatment varies from one country to another, along with access to resources. For instance, in the UK, the NICE standard of care for a chronic neuropathic diabetic wound/ulcer (which is the kind of wound you are referring to, as you started this thread in the `Diabetic foot and wound management` section) is to; reduce any non-viable tissue, take a swab for culture of aerobic and/or anaerobic infection, which leads to the prescription of appropriate broad-spectrum antibiotic therapy (not a folk-lore remedy of vinegar, tree bark, spit or any other dark age tx) and offload the wound.
Incidentally, and further to the scientific evidenced based papers that I posted previously (which demonstrated that vinegar inhibits fibroblast growth) it is also well documented that a moist environment is required for optimal wound healing; see here (for yet another tiresome evidenced based bit of evidence; "yawn" to coin a popular phrase.....) Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing. The full text of this article states "Caustic solutions..... vinegar....should never be applied to the wound". Hmmm. Lemme think why that would be. Acetic acid = moist environment? Nah. You don`t need me to explain the pH balance, I`m sure.
You also need to be clear in your initial enquiry of clinical experience/advice here. Your opening post on this thread asked
Quote:
" Anyone using Vinegar on wounds, pseudomonas infections etc????
I've had some good results, just wondering what other peoples experiences were???
Now, that post lead us to believe that YOU had personally experienced "some good results" from "using vinegar on wounds". But, you then went on to say;
Quote:
I have not personally used vineagar/Acetic Acid on wounds, but have closely watched a Doctors dressing regime
In future posts, please be clear on what it is that you are asking for, or offering advice on, by providing the full clinical scenario/picture. This would lead to less frustration on your part and more comprehensive replies from the community.
I've had some good results, just wondering what other peoples experiences were???
Now, that post lead us to believe that YOU had personally experienced "some good results" from "using vinegar on wounds". But, you then went on to say;
Quote:
Quote:
I have not personally used vineagar/Acetic Acid on wounds, but have closely watched a Doctors dressing regime
Thank you, finally some REAL WORLD CLINICAL experiences.
Cheers for the feedback :)
I checked with the key people at two of the major wound management clinics here in Melbourne and they expressed absolute horror that anyone would be using it!
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A few non-authoritative references to it and its use as an agent for bathing hardly constitutes evidence for its use.
I can not find anyone in the wound management community who uses it. They are all horrified that its being used, especially on the context of the evidence available for other interventions.
I just checked some of the recent wound management textbooks we have here. Only one of them (Carville) even mentioned acetic acid or vinegar.
This is what it said:
Quote:
Advantages:
Effective against pseudomonas aeruginosa
Disadvantages:
Toxic to fibroblasts
Not isotonic or haemolytic
May cause wound pain
May irritate surrounding skin
Lineaweaver et al demonstrated that there is no dilution of acetic acid that is toxic to bacteria without being toxic to fibroblasts. This, there is no concentration of acetic acid which can be safely used in wound healing.
As a podiatrist who has worked in a high risk foot clinic for the last 14 years, we have never used vinegar for wound treatments.
We have heard of it being used once on an inpatient with a leg ulcer by the Dermatology team but it wasn't for Pseudomonas and the wound nurse quickly redirected them to something more appropriate.
In Australia, we have the benefit of accessing all the most effective and evidence based treatments for these conditions. If all aspects of wound healing are addressed, we heal most of these wounds. Our main barrier to healing is patient behaviours.
Although there are many 'alternative' treatments which may be useful in parts of the world where more costly evidence based options are not available, it is often confusing to patients and some practitioners when these are discussed as being effective options in a broader sense.
Perhaps we need to clarify the goal of the wound treatment as our first consideration: sometimes to treat and prevent infection is the primary goal and healing the wound may be secondary to that.
Perhaps if you have no other option and you are stuck in a kitchen somewhere...no I won't even go there!
According to our best evidence, most antimicrobial dressings are very effective against Pseudomonas, including most silver dressings, Medihoney, Iodosorb and topical Flamazine (SSD).
If you can, that would be the best way to go. It works!
Best of luck with wound healing.
Liz Perry
The Alfred Podiatry Service
Melbourne, Australia.
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I have heard of Vinegar being used on foot wounds, and i am sure it has some effect.
however there are more clinically appropiate products available, that are less harmful to tissue that might be trying to heal.
Entani E, Asai M, Taujihata S, Tsukamoto YK, Ohta M. Antibacterial action of vinegar against food-borne pathogenic bacteria including Escherichia coli 0157:H7. J Food Prot. 1998;61:953–959. [PubMed]
Vinegar????
Re: Vinegar????
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