Foot infection in diabetic patients is a huge medical, social and economic problem worldwide. Foot complications are the most common problem in diabetic patients. The risk of developing complicated forms of diabetic foot syndrome throughout life is 12 to 25%. In addition, a very high probability of recurrence. Currently, many researchers are puzzled by the problem of optimizing the treatment of this patient population.

Of particular interest are drugs that have a multiform effect on the purulent-inflammatory process. A study was carried out in one of the clinics in the capital, the aim of which was to evaluate the effect of the prescription of enzymes for patients suffering from a diabetic foot infection. The study is described in the chapter "Polyenzyme preparations in purulent surgery" (VM Koshkin, SV Minaev, Yu. A. Spesivtsev, G. Yu. Knorring. Polyenzyme preparations in surgical practice. Saint-Petersburg: "Man", 2004. - 112 p.). Unfortunately, the description does not contain detailed information on the study design, materials and methods, the presence of a control group, the randomization, the main final parameters evaluated, the presence / absence of patient monitoring. during the follow-up period.

It should be noted that the study obviously involved surgical patients requiring surgical treatment in a hospital setting and full pharmacological support.

Following short-term therapy with enzymes (5-7 days before surgery), the pain syndrome was eliminated, edema of the lower limbs was stopped, temperature, pain and tactile sensitivity decreased. restored and the signs of inflammation disappeared. In 318 patients, amputations of the lower limbs could not be avoided, but the course of the postoperative period went smoothly. After the operation, the intake of enzymes continued at the maximum doses until the inflammatory phenomena had completely subsided. After discharge in a satisfactory state, the patients continued to receive the drug for 8 weeks; Admittedly, the purpose of this appointment from the description of materials and research methods remains unclear. The results enabled the authors to recommend systemic enzyme therapy as an essential element in the treatment of complicated forms of diabetic foot syndrome.

In fact, what was systemic enzyme therapy? Everything is very simple - as it is now called - the appointment of the drug Flogenzim. Its composition: pancreatin 100 mg, papain 60 mg, bromelain 45 mg, trypsin 24 mg, chymotrypsin 1 mg, amylase 10 mg, lipase 10 mg, rutin 50 mg in a tablet. For comparison, we present Mezim-forte (also an enzyme preparation): ED EF 3500 lipases, ED EF 4200 amylases, proteases (including those similar to Flogenzym) ED EF 250. Another drug - Mezim-forte 10000 - lipases ED EF 10000, ED EF 7500 amylases, ED EF 375 proteases.

Phlogenzyme contains microdoses of certain enzymes and bromelain, a plant component (found, for example, in pineapple). The cost of treatment according to the diabetic foot scheme (1 week + hospital treatment + 8 weeks) exceeds $ 1,000. Why not use another drug? For example, Mezim (pancreatin). A well-known brand, an understandable action, a dosage hundreds of times higher than Phloenzyme, can be associated with a moderate diet with pineapple, which does not contradict diabetes.

I hope that researchers can always reduce the percentage of amputations, because in this work, despite all the additives, it remained extremely high. Pharmacoeconomic aspects must be taken into account. The cost of treatment with a miracle enzyme is not affordable for diabetics who, at the time of the development of diabetic foot syndrome, are generally already citizens with disabilities. A drug like pancreatin couldn't empty the pocket as much. Given the amazing data from the successful experience of systemic enzyme therapy, it may be necessary to conduct a comparative study of the drugs Mezim, Pancreatin, Phloenzyme, Wobenzym in the treatment of diabetic foot infections. In addition, knowing what the preparation "Impaza" consists of, I wish to add it to the list of drugs for research. The control group should be divided into isolated pineapple patients and patients with access to pineapple (bromelain). It is only after such a comprehensive approach to the problem that we can truly understand the enormous role that systemic enzyme therapy plays in our clinical practice.

We tried to find similar studies in the US national medical library Medline, which contains about 16 million articles published since the 60s. Last century in more than 4,000 medical and biological journals. Since the main part of the drug consists of pancreatic enzymes, the search was carried out in the MeSH database for the keywords "diabetic foot" and "pancreolipase", ie the accent a was put on the identification of studies on the use of pancreatic enzymes in the treatment of diabetic foot syndrome. No publication was found for this request.

Nevertheless, we do not lose optimism - for further immersion in the problem, we recommend a number of scientific publications in Russian: