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A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review.

ABSTRACT: BACKGROUND:Antimicrobial photodynamic therapy (aPDT) is a growing approach to treat skin and mucosal infections. Despite its effectiveness, investigators have explored whether aPDT can be further combined with antibiotics and antifungal drugs. OBJECTIVE:To systematically assess the in vivo studies on the effectiveness of combinations of aPTD plus antimicrobials in the treatment of cutaneous and mucosal infections. MATERIALS AND METHODS:Searches were performed in four databases (PubMed, EMBASE, Cochrane library databases, ClinicaTrials.gov) until July 2018. The pooled information was evaluated according to the PRISMA guidelines. RESULTS:11 full-text articles were finally evaluated and included. The best aPDT combinations involved 5-aminolevulinic acid or phenothiazinium dye-based aPDT. In general, the combination shows benefits such as reducing treatment times, lowering drug dosages, decreasing drug toxicity, improving patient compliance and diminishing the risk of developing resistance. The mechanism of action may be that first aPDT damages the microbial cell wall or membrane, which allows better penetration of the antimicrobial drug. LIMITATIONS:The number of studies was low, the protocols used were heterogeneous, and there was a lack of clinical trials. CONCLUSIONS:The additive or synergistic effect of aPDT combined with antimicrobials could be promising to manage skin and mucosal infections, helping to overcome the microbial drug resistance.

SUBMITTER: Perez-Laguna V

PROVIDER: S-EPMC6520109 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review.

Pérez-Laguna Vanesa V Gilaberte Yolanda Y Millán-Lou María Isabel MI Agut Montserrat M Nonell Santi S Rezusta Antonio A Hamblin Michael R MR

Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology 20190501 5

<h4>Background</h4>Antimicrobial photodynamic therapy (aPDT) is a growing approach to treat skin and mucosal infections. Despite its effectiveness, investigators have explored whether aPDT can be further combined with antibiotics and antifungal drugs.<h4>Objective</h4>To systematically assess the in vivo studies on the effectiveness of combinations of aPTD plus antimicrobials in the treatment of cutaneous and mucosal infections.<h4>Materials and methods</h4>Searches were performed in four databa ...[more]

PMID: 30821303

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Project description:BackgroundPhotodynamic therapy (PDT) is increasingly used for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, it is unknown whether photodynamic therapy is more effective than other commonly used treatment modalities for these cancers.PurposeThe aim of this study was to determine the relative efficacy and safety of PDT compared with placebo or other interventions for the treatment of skin carcinomas.MethodsSearches were performed in PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases. We included randomized controlled trials comparing the PDT with other interventions in adults skin BCC or SCC that reported on lesion response, recurrence, cosmetic appearance, or safety outcomes.ResultsSeventeen unique randomized controlled trials, representing 22 study arms from 21 publications were included. The included trials included 2,166 participants, comparing methyl aminolevulinic (MAL) PDT (six studies) or aminolevulinic acid (ALA) PDT (two studies). Comparators included placebo, surgery, hexaminolevulinic (HAL) PDT, erbium: yttrium-aluminum-garnet ablative factional laser (YAG-AFL) PDT, fluorouracil, and imiquimod. There were few studies available for each comparison. Mantel-Haenszel fixed effects risk ratios were calculated for response, recurrence, cosmetic outcomes, and adverse events. MAL-PDT had similar response rates to surgery, ALA-PDT, fluorouracil and imiquimod at 3- and 12 months post-intervention. The rate of recurrence was similar, showing few differences at 12 months, but at later time points (24-60 months), fewer lesions recurred with surgery and imiquimod than with PDT. PDT also caused more adverse events and pain than other interventions. However, PDT treatment was more likely to receive a "good" or "excellent" rating for cosmetic appearance than surgery or cryotherapy.ConclusionThis systematic review and meta-analysis demonstrates that the choice of treatment modality for BCC or SCC is best chosen in the context of the location and size of the lesion, the socioeconomic circumstances of the patient, as well as the patient's preferences. We call for more high quality studies to be done, in order to enable more reliable interpretations of the data.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=368626, identifier CRD42022368626.

Dataset Information

A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review.

Publications

A combination of photodynamic therapy and antimicrobial compounds to treat skin and mucosal infections: a systematic review.

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