Medical Ozone: Therapeutic Mechanisms, Clinical Practice and Standardized Application

Medical ozone (O₃) is the clinical oxygen-ozone mixture of ozone produced at controlled concentrations with very high purity levels for medical use. Ozone used in this clinical application has different properties than industrial-grade ozone (poisonous) and has a wide range of effects such as sterilization, anti-inflammation, analgesic properties, regulating the immune system, and enhancing microcirculation. This paper provides a brief overview of the therapeutic mechanisms of action for medical ozone as well as the clinical applications of medical ozone, standard protocol guidelines for use, and safety rules for medical practitioners and researchers.

Keywords: medical ozone, ozone therapy, anti-inflammatory sterilization, clinical application, safety management

1. Definition and Key Characteristics Medical ozone is generated through the use of medical ozone generators using only medical-grade oxygen at high purity under sterile conditions. The primary benefit of medical ozone is the controllable low-level oxidation. Because the concentration of ozone is stable; high quality (free of contaminants); and does not produce any toxic by-products, it meets all criteria for clinical safety. Medical ozone is soluble in body fluids and produces low-level oxidative stress to stimulate self-healing in humans. Since the use of medical ozone is of a physical nature, there are no side effects from drugs or chemical compounds and was intended for use in a clinical setting as a primary form of treatment or as a supplement to another treatment option.
2. Therapeutic Mechanisms Medical ozone has the ability to produce broad-spectrum clinical efficacy through four primary mechanisms of action (biological pathways). 2.1 Broad-Spectrum Sterilization Medical ozone will oxidize and destroy the structures and genetics of bacteria, fungi, viruses and parasites, therefore sterilizing the infectious lesions. Medical ozone does not produce resistance to antiviral medications like antibiotics do, therefore, the use of medical ozone to treat infections can be effective when other antimicrobial agents have failed. 2.2 Anti-Inflammation and Analgesic Properties Medical ozone will inhibit the formation and activity of NF-κB and the production of pro-inflammatory cytokines in order to prevent further inflaming of lesions; stimulate the production of endocannabinoids; decrease the sensitivity of nerves to pain; promote A2 protein clearance from tissue; and to decrease(2.3) The immune system is regulated by stimulating immune cells with low concentrations of ozone as well as producing cytokines to keep Th1/Th2 balance in homeostasis. This results in improved natural immunity to viruses, decreased immune system-related chronic inflammation. (2.4) Medical ozone therapy enhances cell proliferation and granulation of tissue through increased blood circulation, lymphatic drainage, vasodilation from the release of vasoactive factors, which results in increasing the oxygen delivered to tissues. This speeds up the healing process of chronic wounds. (3) Standardized medical ozone therapies have clinically been used with proven safety and efficacy across many specialties. (3.1) The most developed use of standardized medical ozone therapy is in the area of orthopedic pain relief for lumbar, cervical and soft tissue ailments due to hernias, ruptured discs, spondylolysis, osteoarthritis and inflammatory processes by temporarily interrupting nerve conduction and reducing inflammation through local or intra-articular injection. (3.2) Dermatology practices have used ozone therapy to aseptically sterilize and promote healing of difficult-to-heal wounds resulting from multiple types of skin infections, herpes, diabetic foot ulcers, decubitus ulcers through the use of ozone water fumigation and/or irrigation. (3.2.1) Ozone therapy has also been used for localized anaerobic infections caused by periodontal disease and/or pericoronitis. Ozone therapy has also been helpful in rehabilitating patients with systemic co-morbidities due to chronic inflammatory disease since ozone is known to have positive effects on the immune system. Ozone has been successfully utilized with water rinses for treatments of bacterial vaginosis, cervicitis and pelvic inflammatory disease. Ozone is utilized for water irrigation to assist in the cleansing, sterilizing and restoring normal flora of the vagina without causing the adverse side effects associated with antibiotic treatment. (3.3) Ozone therapy has also been used by dentists to rehabilitate patients who have suffered from chronic diseases due to chronic metabolic and/or immune disorders resulting in restoration of blood oxygen levels, improvement of overall immunity and rehabilitation through systemic immune modulation. (4) Standardized applications (methods of delivery and dosing) are controlled by three methods, and each of these methods are controlled by strict parameters regarding ozone concentration levels: 1) Local injections at concentrations of 40-60 µg/mL 2-3 times per week for orthopedic and pain conditions; 2) Use of sterile ozone water for the flushing of nail beds, vaginal canals and oral cavities for treatment for infectious conditions; and 3) Use of extra corporeal autohemotherapy to improve blood oxygen and to rehabilitate immune compromised patients with underlying chronic metabolic/immune disorders. (5) Standardized protocols should define standard operational protocols as well as determine contraindications prior to use of ozone therapy. (5.1) Ozone therapy has absolute contraindications such as patients who have a proven allergy to ozone; patients with acute hemorrhage; patients with uncontrolled hyperthyroidism; patients who have had an acute myocardial infarction. (5.2) Some patients have relative contraindications, i.e., pregnant or breastfeeding women; children who cannot be comprehensively screened; patients with severe organ failure due to chronic disease and become immune compromised patients, so they will require comprehensive screening and close monitoring of low-dose ozone for both type of administration. (5.3) The delivery of ozone therapy requires medical ozone delivery systems that are capable of accurately measuring/delivering appropriate dosing with an aseptic method, and continuously observe patients for possible excessive oxidative stress and iatrogenic-related side effects. (6) Ozone therapy has been found to be a non-invasive drug-free physical therapy modality and supports traditional therapeutic modalities in the management of chronic infections and chronic inflammation. With the ongoing development of ozone therapy systems and ongoing developments in pharmacology and ozone therapy, the use of ozone therapy is being expanded for clinical applications in the areas of rehabilitation, surgical and chronic wound healing. When the standardized clinical systems increase and clinically-based examples of ozone therapy, ozone will become the standard of care in various clinical settings as a targeted adjunctive treatment for patients with chronic disease. (7) Ozone therapy is effective for overall treatment outcomes by promoting the following effects in all medical disciplines – sterilization, anti-inflammation, pain relief and immune modulation, confirming ozone’s position as an adjunctive treatment for patients with chronic disease. The benefits resulting from the accurate delivery and appropriate measurement of ozone as a method of ozone therapy according to established medical clinical guidelines will enhance the potential use of ozone therapy in evidence-based medical/rehabilitative settings for the foreseeable future.