Citric acid treatment of

necrotizing fasciitis: a
report of two cases
Authors: Basavraj S Nagoba, Rajan C Gandi, Bharat
J Wadher, Sanjay P Gandhi, Sohan P Selkar

Alexandra Giraldo, Karen Alvarez, Joe Stapleton

Critical Analysis
Citric acid treatment of necrotizing fasciitis: a report of two case studies
(Nagoba, Gandhi, Wadher, Gandhi, Selkar, 2010)

Introduction
Methodology
Results
Discussion
Questions/Future Research
Reference

Introduction
Necrotizing Fasciitis is a destructive invasive infection of the skin, subcutaneous tissue
and deep fascia, with relative sparing of muscle.
A life threatening surgical emergency
needs early diagnosis , prompt and aggressive debridement
definitive therapy with intravenous fluids and antibiotics
inotropic support and sometimes oxygenation.
Two case studies
no response to conventional treatment
treatment with 3% citric acid

Methodology
Two case studies:
40 year old non diabetic male with a history of above knee amputation of left leg 10 years
back. Presented with complaints of fever, pain in back extremities and swelling of right
thigh.
60 year old non diabetic female presented with fever, chills, soft tissue infection of left leg
with blebs and skin discoloration.

Methodology
40 year old male:
Treatment Plan:
IV fluids and started on antibiotics.
Medications included: Ceftizoxime, netromycin, crystalline penicillin.
Infection extended up to anterior and posterior abdominal wall of right side and blebs developed on
thighs.
Surgical debridement and culture analysis
Culture analysis revealed Staphylococcus Aurus and Escherichia (resistant to most
antibiotics).
3% citric acid treatment was started.
Pads soaked with 3% citric acid were place on wound.
Treatment was continued for 20 days with a total of 11 dressings with citric acid.

Methodology
60 year old female:
Treatment plan:
Medications included: ciprofloxacin, metronidazole, injection of amoxycillin & clavulanic acid
Infection was found on medial aspect of thigh, calf, ankle, and dorsum.
Obtained culture of necrosed skin and revealed Streptococcus pyogenes.
3% citric acid treatment was started after thorough debridement
Acid was applied daily in form of wound irrigation and pads on raw area.
20 applications were performed.

Results
First patient:
The disease spread after the intravenous fluid along with antibiotics, ceftizoxime 2 gm BD,
netromycin 300 mg OD, 2,000,000 units of crystalline penicillin, and 500 mg of
metronidazole
After the 3% citric acid treatments of wound irrigation and wound wash the patient began
forming healthy granulation tissue but due to the size of the area a skin graft was needed
to cover the leg.
Second patient:
While taking ciprofloxacin and metronidazole with amoxycillin and clavulanic acid the
patient had infections up the ankle calf and thigh in the deep fascia
After receiving 3% citric acid wound wash and wound irrigation treatments the patient the
disease stopped spreading and the body started to produce healthy granulation tissue
The wound received a skin graft in order to close it

Results
The hypothesis states that the use of 3% citric acid can assist wound
management following surgical treatment with antibiotics
given the two patients results, the hypothesis could be considered true
Since the results are only based on two patients the hypothesis can not be
concluded as truth
Given more data, you may be able to make an argument but until more cases
use 3% citric acid to clean necrotizing fasciitis and manage wounds post
surgery the statistics can not back up the hypothesis

Discussion
It is most commonly caused by an infection with group A Streptococcus
Life threatening condition
Must be diagnosed early
When conventional treatment does not work, Citric acid is reliable.
Citric acid is also effective on other chronic wound infections, reporting in
4/6
It has been found that citric acid can stimulate the healing of skin faster
It can soon be the leading treatment option for the clinical management of
necrotizing fasciitis

Questions/Future Research
No future research has been done since the two cases and since both patients had to
sign off on receiving the treatment it should not be the first treatment received.
The process was not mentioned in any detail which could cause difficulties with any
who chose to attempt the wound wash and wound irrigation
The treatment was meant for not only serious cases such as necrotizing fasciitis but also
other cases involving large breakages in the skin where infections are most probable
This is something that people could use in their daily lives and not for medical
professionals
The patients were unable to afford modern medicine so the 3% citric acid
treatment was the best possible

References
Nagoba, B. S., Gandhi, R. C., Wadher, B. J., Gandhi, S. P., & Selkar, S. P. (2010). Citric acid treatment of necrotizing fasciitis: a
report of two cases. International Wound Journal, 7(6), 536-538. doi:10.1111/j.1742-481X.2010.00721.x