{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T02:38:37Z","timestamp":1780367917498,"version":"3.54.1"},"reference-count":19,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,20]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Surgical site infections still remain a major public health challenge and have become an increasing universal risk, especially for the implantation of orthopaedic devices.<\/jats:p><jats:p>Unfortunately, the discovery and increasingly widespread use (especially the misuse) of antibiotics have led to the rapid appearance of antibiotic-resistant strains today; more and more infections are caused by microorganisms that fail to respond to conventional treatments.<\/jats:p><jats:p>Oxygen-ozone therapy has been extensively used and studied for decades across various potential medical applications and has provided consistent effects with minimal side effects.<\/jats:p><jats:p>This study aims to determine the superiority of oxygen-ozone therapy in combination with oral antibiotic therapy in patients with wound infections after an orthopaedic device implantation when compared with antibiotic therapy alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>This is an open-label, multicentre, randomised, parallel-group study that aims to assess the efficacy and safety of oxygen-ozone therapy in combination with oral antibiotic therapy to treat infections in patients (male or female aged \u226518 years) having undergone surgery for the implant of an orthopaedic device. Patients must have at least one (but no more than three) postoperative wounds in the site of surgery (ulcers, eschars and sores) and at least one symptom (pain, burning, redness and malodour) and at least one sign (erythema, local warmth, swelling and purulent secretion) of infection of at least moderate intensity (score \u22652) in the target lesion at the screening visit (patients with wounds without signs of localised infection or with undermining wounds will be excluded).<\/jats:p><jats:p>Patients (n=186) will be recruited from five Italian hospitals and studied for 7 weeks. All will be assigned to one of the two treatment groups according to a web-based, centralised randomisation procedure and placed into either the (1) intervention: oxygen-ozone therapy 2\u20133 times a week for 6 weeks (for a maximum of 15 sessions) simultaneously with an appropriate oral antibiotic therapy prescribed at baseline or (2) control: oral antibiotic therapy prescribed at baseline.<\/jats:p><jats:p>The primary outcome is the efficacy and superiority of the treatment (ozone and oral antibiotic therapies); secondary outcomes include the resolution of signs and symptoms, modifications in lesion size and the treatment\u2019s safety and tolerability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>This study has been reviewed and approved by the responsible Independent Ethics Committee (IEC) of COMITATO ETICO CAMPANIA NORD, located at \u2018Azienda Ospedaliera San Giuseppe Moscati di Avellino\u2019.<\/jats:p><jats:p>After completion of the study, the project coordinator will prepare a draft manuscript containing the final results of the study on the basis of the statistical analysis. The manuscript will be derived by the co-authors for comments, and after revision, it will be sent to a major scientific journal. Findings will be disseminated via online and print media, events and peer-reviewed journals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04787575\">NCT04787575<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076739","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T05:32:14Z","timestamp":1704864734000},"page":"e076739","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Use of oxygen-ozone therapy to improve the effectiveness of antibiotic treatment on infected arthroplasty: protocol for a superiority, open-label, multicentre, randomised, parallel trial"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct04787575","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6499-0734","authenticated-orcid":false,"given":"Fidelia","family":"Cascini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianno","family":"Franzini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Andreoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Manzotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-1078","authenticated-orcid":false,"given":"Chiara","family":"Cadeddu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Quaranta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-6186","authenticated-orcid":false,"given":"Andrea","family":"Gentili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Ricciardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"2024022401002764000_14.1.e076739.1","article-title":"Biofilm disrupting technology for orthopedic implants: what's on the horizon?","volume":"1","author":"Connaughton","year":"2014","journal-title":"Front Med (Lausanne)"},{"key":"2024022401002764000_14.1.e076739.2","first-page":"224","article-title":"Prevention of surgical site infections in orthopaedic surgery: a synthesis of current recommendations","volume":"23","author":"Tucci","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2024022401002764000_14.1.e076739.3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13018-015-0294-5","article-title":"Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama","volume":"10","author":"Roman\u00f2","year":"2015","journal-title":"J Orthop Surg Res"},{"key":"2024022401002764000_14.1.e076739.4","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23656"},{"key":"2024022401002764000_14.1.e076739.5","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24230"},{"key":"2024022401002764000_14.1.e076739.6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/2045-9912.235139","article-title":"Ozone therapy in conjunction with oral antibiotics as a successful primary and sole treatment for chronic septic prosthetic joint: review and case report","volume":"8","author":"Rowen","year":"2018","journal-title":"Med Gas Res"},{"key":"2024022401002764000_14.1.e076739.7","doi-asserted-by":"publisher","DOI":"10.4103\/0976-9668.82319"},{"key":"2024022401002764000_14.1.e076739.8","unstructured":"Bocci V . 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