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Doc Touts New Treatment for Flesh-Eating Disease

Hypochlorous acid does the trick

In a recent radio interview, John R. Crew, MD, Medical Director of the Advanced Wound Care Center at Seton Medical Center in Daly City, California, described a promising new treatment for necrotizing fasciitis, commonly known as flesh-eating disease.

“As Dr. Crew said in the interview, doctors are having great success with a new treatment that Dr. Crew has pioneered,” said Jacqueline Roemmele, executive director of the National Necrotizing Fasciitis Foundation (NNFF). “But many doctors and patients aren’t yet aware that this treatment exists. So, tragically, victims continue to lose their lives or have limbs amputated because of this terrible disease.”

Necrotizing fasciitis kills up to 20% of patients even with aggressive treatment.

As Crew explained in the interview, the disease has been known since the age of Hippocrates. It begins when bacteria get under the skin and start to spread. The body tries to fight the infection, but toxins from the bacteria and the reaction of the body’s own immune system eat away tissue. “The body starts digesting itself,” Crew said.

Many types of bacteria can cause the disease, including Group A and Group B Streptococcus; Streptococcus pyogenes; Streptococcus agalactiae; Staphylococcus aureus; Vibrio vulnificus; Clostridium perfringens; and Bacteroides fragilis. Such infections are more likely to occur in people with compromised immune systems.

The traditional treatment is to kill the bacteria with antibiotics and “to cut until you get rid of all the areas affected,” Crew explained. But because the tissue can die so fast, “people lost arms, legs, or their lives very quickly.”

In the new treatment, doctors irrigate the wound with NeutroPhase (NovaBay Pharmaceuticals), a wound cleaner containing hypochlorous acid — a substance found inside white blood cells that has the ability to kill bacteria, according to Crew.

In laboratory studies, the treatment was shown to neutralize staphylococcal alpha toxin, streptococcal streptokinase, and other potentially deadly toxins associated with flesh-eating bacteria.

In October 2013, Crew and his colleagues published a report on the use of pure hypochlorous acid solution 0.01% (NeutroPhase) and negative-pressure wound therapy (NPWT), along with debridement and antibiotics, in a 51-year-old woman with acute necrotizing fasciitis of the left elbow.

The patient initially presented at a hospital with fever, and her left arm had swelling and tenderness. She went into sudden shock, with an unobtainable blood pressure. She was immediately transferred to the coronary care unit for resuscitation. There, she was diagnosed with cellulitis.

Six days after admission, the patient experienced sudden skin blistering, swelling, and pain in her left arm, with her white blood cell count rising to 16,000. A surgical consultation resulted in an emergency subfascial incision and drainage. NPWT was placed on the upper arm, and the unaffected area was irrigated with hypochlorous acid solution every 4 hours. The patient’s condition slowly improved, and she was discharged home, where her husband continued to use the same technique of instillation, three times every 24 hours, with a home NPWT device. The patient was also given oral ceftazadime. She healed completely.

A cytotoxicity assay was performed using human lung epithelial cells to evaluate the effectiveness of the irrigation solution in inactivating bacterial toxins. It was determined that 0.1 mcg/mL of the solution (1,000 dilution) completely inactivated alpha-hemolysin toxin.

In addition, the inactivation of streptokinase by the irrigation solution was determined using an enzymatic assay. In this assessment, 0.001 mcg/mL of the solution (100,000 dilution) completely inactivated streptokinase.

Crew has overseen the successful treatment of more than two dozen patients.

“It’s extremely important to recognize the disease for what it is, and that there is something available to treat it,” he said.

Sources: PR Newswire; July 24, 2014; and Wounds; October 2013.

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