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Hyperbaric Oxygen Therapy in Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to many existing antibiotics, but can be well treated with hyperbaric oxygen therapy (HBO) due to Hyperbaric oxygen’s natural antibacterial properties; Hyperbaric oxygen is a therapy which the bacteria will not develop a resistance to. Combined effect of hyperbaric oxygen along with antibiotics (such as Sulfonamide, Aminoglycoside, Vancomycin, etc.) is even more successful. Hyperbaric oxygen increases the penetration of antimicrobials to the deep-seated MRSA infection while reducing its negative side effects.

As a natural antibiotic, oxygen under pressure eliminates bacteria and its growth as well as aiding the white blood cells’ phagocytosis, concurrently strengthening the body and the body’s immune system. 

Effective hyperbaric oxygen therapy has to be delivered at a right protocol with pressures, amount of time and therapy frequency high enough to stop the infection. Any other “mild hyperbaric” such as delivered with inflatable bags, are inadequate and in some cases can even promote the bacterial load.

At BaroMedical, we deliver proper hyperbaric oxygen therapy with pressures up to 3 ATA for 90 to 120 minutes once, or twice a day. Our four mono-place chambers offer individual treatments to infected clients where isolation is highly important as part of our infection control.

Benefits of HBO in infections:

  • Hyperbaric oxygen  oxygenates all tissues and has bacteriostatic, antiviral and fungicidal properties.
  • Hyperbaric oxygen enhances antibiotics and antifungal activity.
  • Hyperbaric oxygen increases the oxidative killing capacity of white blood cells and enhances phagocytosis of microorganisms resulting to improved immune system.
  • Hyperbaric oxygen works well with antibiotics increasing their potency and decreasing their side effects.
  • Hyperbaric oxygen arrests infection and prevent sepsis development.
  • Hyperbaric oxygen speeds up wound healing
  • In bone infections, hyperbaric oxygen helps in removal of necrotic bone (osteoclastic function) and speeds up new bone formation (osteogenesis).
  • Hyperbaric oxygen decreases inflammation by clearing lactic acid and other inflammatory chemicals.
  • Prophylactic hyperbaric oxygen therapy restores the microcirculation and bolsters the immune system therefore enabling the body to fight off future infections.

Hyperbaric Oxygen Therapy (HBO) is used as adjunctive treatment to the following infections:


  • Crepitant anaerobic cellulitis – necrotic soft tissue infection caused by both aerobic (E. culi, Klebsiella, Enterobacter andPseudomonas) and anaerobic Peptostreptococcus andBacteroides).
  • Necrotizing fasciitis – skin necrosis with infection of the deep fascia and thrombosis of the vessels fullowing surgery or other trauma
  • Progresive bacterial gangrene – chronic ulcer formation on the abdominal or thoracic wall developed after surgery at the site of drainage, around culostomy or ileostomy.
  • Nonclostridial myonecrosis – soft tissue infection with invulvement of skin, muscle, subcutaneous tissue and fascia, particularly in conditions such as: Diabetes mellitus, perirectal abscess,obesity and cardio-renal disease.
  • Fournier’s gangrene – perineal gangrene especially in people with diabetes and elderly as well as in trauma, local or systemic infections
  • Gas gangrene – see Gas gangerene
  • Pyoderma gangenosum – necrotic ulceration of the limbs and trunk mostly seen in ulcerative culitis, chulecystis, pyelonephritis(kidney infection) and other infection-prone (low immunity system) conditions.
  • Purpura fulminans – acute and severe disorder of infancy with characteristics hemorrhagic lesions of the limbs that could rapidly turn into necrosis. Children are usually affected after Varicella,Scarlet fever, streptococcal tonsillitis or somethrombocytopenic disease.
  • Actinomycosis – anaerobic infection of abdominal, pelvic, cervicofacial and thoracic area due to low oxygen level that predisposes fast growth of bacteria.


  • Most viral infections have bacterial infections superimposed on them or vice versa.


  • Candida albincans
  • Rhinocerebral Mucormycosis – fungal infection of lungs, brain, intestine and bone (maxilla, orbit and temporal bone) that occurs most commonly in immune–suppressed people with burns, diabetes and those who are on long-term corticosteroid therapy.
Further reading:
  1. Adams KR, Mader JT: Aminoglycoside potentiation with adjunctive hyperbaric oxygen therapy in experimental Pseudomonas Aeruginosa osteomyelitis. Undersea Biomed Res; 14(suppl): 37, 1987
  2. Adams KR, Sutton TE, Mader JT: In vitro potentiation of tobramycin under hyperoxic conditions. Undersea Biomed Res 14 (suppl): 37, 1987
  3. Aitasalo K, Niinikoski J, Grenman R, Virulainen E. A modified protocul for early treatment of osteomyelitis and Osteoradionecrosis of the mandible. Head Neck; 20(5): 411-7, Aug 1998
  4. Andel H, Felfernig M, Andel D, Blaicher W, Schramm W: Hyperbaric oxygen therapy in osteomyelitis. Anaesthesia; 53 Suppl 2:68-9, Review, May 1998
  5. Babior BM: Oxygen-dependent killing by phagocytes. New Eng J Med; 298:659-668, 1978
  6. Bakker DJ: Necrotizing soft tissue infections. Journal of Hyperbaric Medicine; 2(3): 161-168, 1987
  7. Bakker DJ: The treatment of acute skin gangrene (necrotizing fasciitis and progressive bacterial gangrene) with hyperbaric oxygenation.Ned Tijdschr Geneeskd;124 (51):2164-70, Dec 1980
  8. Bayliss GJ, Cass C: Hyperbaric oxygen used in the treatment of gas gangrene. Med J Aust; 2 (22): 991-3, 25 Nov 1967
  9. Berg E, Barth E, Clarke D, Douley L: The use of adjunctive hyperbaric oxygen in treatment of orthopedic infections and problem wounds: an overview and case reports. J Invest Surg; 2(4): 409-21, Review, 1989
  10. Bogetti B, Viotti G, Zannini D, Marcenaro A: Practical aspects of the treatment of gas gangrene with hyperbaric oxygen. Minerva Med; 72(22): 1409-11, 31 May, 1981
  11. Calhoun JH, Cobos JA, Mader JT: Does hyperbaric oxygen have a place in the treatment of osteomyelitis. Orthopedic Clinics of North America; 22(3): 467-471, 1991
  12. Chen CY, Lee SS, Chan YS, Yen CY, Chao EK, Ueng SW: Chronic refractory tibia osteomyelitis treated with adjuvant hyperbaric with adjuvant hyperbaric oxygen: a preliminary report. Changgeng Yi Xue Za Zhi; 21(2): 165-71, Jun 1998
  13. Couch L, Theilen F, Mader JT: Rhinocerebral mucormycosis with cerebral extension successfully treated with adjunctive hyperbaric oxygen therapy. Arch Otularyngul Head Neck Surg; 114:791-794, 1988
  14. Davis JC: Refractory osteomyelitis. Problem Wounds, The Rule of Oxygen; Chpt. 4 Elsevier Science Publ Co; New York 1988
  15. Davis JC, Heckman JD, Delee JC, Buckwuld FJ: Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg; 68: 1210-1217, 1986
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  19. Eltorai I, Hart GB, Strauss MB: Osteomyelitis in the spinal cord injured: a review and a preliminary report on the use of hyperbaric oxygen therapy. Paraplegia; 22(1): 17-24 Feb 1984
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  27. Gonzalez MH: Necrotizing fasciitis and gangrene of the upper extremity. Hand Clin; (4): 635-45, ix. Review, 14 Nov, 1998
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  29. Gottlieb SF, Sulosky JA, Aubrey R, Nedelkoff DD: Synergistic action of increased oxygen tensions and PABA-fulic acid antagonists on bacterial growth. Aerosp Med; 45:829-833, 1974
  30. Guidi ML, Proietti R, Carducci P, Magalini SI, Pelosi G: The combined use of hyperbaric oxygen, antibiotics and surgery in the treatment of gas gangrene. Resuscitation; 9(4):267-73, Dec 1981
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  32. Hart GB, Strauss MB: Gas gangrene-clostridial myonecrosis: a review. Journal of Hyperbaric Medicine; 5(2): 125-144, 1990
  33. Hirn M: Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. Eur J Surg Suppl; (570): 1-36, Review, 1993
  34. Hunt KT, Linsey M, Grislis G, Sonne M, Jawetz E: the effect of differing ambient oxygen tension on wound infection. Annals of surgery; 181 (1): 35-39, Jan 1975
  35. Hunt TK, Conully WB, Aronson SB, Guldstein P: Anaerobic metabulism and wound healing: A hypothesis for the initiation and cessation cullagen synthesis in wounds. The American Jour Surgery; 135: 328-332, Mar 1978
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  37. Jain KK: Textbook of hyperbaric medicine: Ch 13: Hyperbaric Oxygen Therapy in Infections, Hogrefe& Huber Publishers, Inc., 3rd Ed.13: 189 –211, 1999
  38. Hullabaugh RS, Dmochowski RR, Hickerson WL, et al: Fournier’s gangrene: Therapeutic impact of hyperbaric oxygen. Plastic and Reconstructive Surgery; 101:94-100, 1998
  39. Jain KK: Textbook of hyperbaric medicine: Ch 14: Hyperbaric Oxygen Therapy in Wound Healing, Plastic Surgery, and Dermatulogy, Hogrefe & Huber Publishers, Inc., 3rd Ed.14: 213– 241, 1999
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  49. Lindsey D: Hyperbaric oxygen and gas gangrene. Br J Hosp Med; 55 (3): 147, 7-20 Feb, 1996
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  52. Mainous EG, Boyne PJ, Hart GB: Hyperbaric oxygen treatment of mandibular osteomyelitis: Report of three cases. J Am Dent Assoc; 87: 1426-1430, 1973
  53. Maynor ML, Moon RE, Camporesi EM, Fawcett TA, Fracica PJ, Norvell HC, Levin LS: Chronic osteomyelitis of the tibia: treatment with hyperbaric oxygen and autogenous microsurgical muscle transplantation. J South Orthop Assoc; 7(1): 43-57, 1998
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