Citric acid and soap against biofilms

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This is one of the current, promising ideas that will soon be ttested against biofilms.---------Am J Rhinol Allergy. 2009 Nov-Dec;23(6):597-601.In vivo effects of citric acid/zwitterionic surfactant cleansing solution on rabbit sinus mucosa.Tamashiro E, Banks CA, Chen B, Gudis DA, Dogrhamji L, Myntti M, Medina J, Chiu AG, Cohen NA.Department

of Otorhinolaryngology-Head and Neck Surgery, University of

Pennsylvania, Philadelphia, Pennsylvania, USA; Division of

Otolaryngology-Head and Neck Surgery, Philadelphia Veterans

Administration Medical Center, Philadelphia, Pennsylvania, USA.BACKGROUND:

Chronic rhinosinusitis that is refractory to medical or surgical

intervention may involve a particularly resistant form of infection

known as a bacterial biofilm that is recalcitrant to antibiotics

secondary to physical barrier characteristics. Recently, a novel sinus

cleansing solution, citric acid/zwitterionic surfactant (CAZS) was

shown to be extremely effective in disrupting biofilms in vitro. The

purpose of this study was to determine the effects of CAZS on sinonasal

epithelium In vivo compared with normal saline. METHODS: Indwelling

catheters were placed into the right maxillary sinus of New Zealand

white rabbits. CAZS solution or normal saline (10 mL) was instilled at

a rate of 20 mL/minute into the sinus followed by aspiration. Rabbits

were killed 1, 3, and 6 days after treatment. Mucosa from both

maxillary sinuses was harvested and evaluated for physiological

activity (ciliary beating) as well as morphological integrity of the

epithelium by scanning electron microscopy. RESULTS: One day after

treatment, beating cilia was evident with morphological analysis shown

intact epithelium with 80-85% denudation of cilia compared with saline.

Three days after treatment, ciliary activity was again noted with

morphological evidence of persistent denuded cilia. By day 6 after

treatment, the epithelium had regenerated cilia over the apical

surface. Throughout the recovery period beating cilia was evident in

CAZS-treated sinuses. CONCLUSION: This study shows that although CAZS

acutely denudes respiratory cilia, the remaining cilia are active.

Additionally, the epithelial barrier appears intact with active

ciliogenesis, and reciliation of the mucosal surface occurring 6 days

after treatment.