Original: Spanish

MADRID DECLARATION ON OZONE THERAPY
Approved at the "International Meeting of Ozone Therapy Schools" held at the Royal
Academy of Medicine in Madrid on the 3rd and 4th of June, 2010, under the auspices of
the Spanish Association of Medical Professionals in Ozone Therapy (AEPROMO)Taking into account that since the discovery of ozone by the German chemist ChristianFriedrich Schönbein in 1840, its medical use has increased in different parts of theworld; there is more interest from health professionals to know how it works and what
are its benefits; the number of ozone therapists keeps growing all around the world; andan increasing number of patients are benefiting from it. However its consolidation has
not been easy, resistance it still found within the medical community and its recognitionin the legal field will require more and coordinated efforts.
Recalling that pre-clinical research and clinical trials on the use of ozone therapy havebeen carried out in Cuba, Germany, Italy, Russia and other countries, with considerable
scientific rigor, obtaining results that support its practice using different medical
protocols.
Bearing in mind that the preclinical studies, genotoxics, toxicology and clinical studies
carried out, endorse the application and the innocuous character of this medical therapy
using a fairly wide range of doses.
Emphasizing that research and clinical experience with medical ozone are making
progress, despite the various obstacles they face, becoming a permanent challenge forresearchers and for ozone therapy associations, mainly due to the lack of access tofinancial resources which they need in order to be able to continue with the scientificresearch that is required.
Stating that it is absolutely necessary to work with specific objectives, planning
globally those necessary actions, so that ozone therapists working together will be
forwarding with great precision and securely the practice of ozone therapy.
Recognizing that there is variance that the medical community wishes to standardize,and that progress already has been made, that it should be taken into account; it isnecessary to continue with the development of medical definitions of procedures andprotocols determining the best applications where it is necessary, as well as a code ofgood practice, in order to overcome more efficiently the possibility of malpractice.
Welcoming with great satisfaction that ozone therapy practice was regularized in
Russia in 2007 by the Federal Service Public Health Control and Social Development,
the first country in the world to do so; in Cuba in 2009, by the Ministry of Public
Health; in Spain, by the Balearic Islands, and the Canary Islands (2007), Madrid (2009)
and Galicia, Castilla-La Mancha, and Castilla y León (2010) Autonomous
Communities; that in Italy significant advances have been done towards ozone therapy
by the Regions of Lombardy (2003), Emilia-Romagna (2007) and Marche (2009), andfavorable court decisions have been taken by the Administrative Court of Lazio (1996and 2003).
The speakers at the "International Meeting of Ozone Therapy Schools" as well as theassociations of ozone therapy present at the same have adopted the following

CONCLUSIONSFirst. To approve the "Therapeutic Ranges for the Use of Ozone” detailed within the“Recommendations" section of this Declaration.
Second. To increase the exchange of knowledge, research, and experiences, both
positive and negative that occur in the field of ozone therapy, in furtherance ofincreasing the knowledge of the huge benefits that this therapy has. To stimulate thepublications of research results in specialized medicine journals.
Third. To encourage health researchers to increase their creative efforts, so that, ozone
therapy continues to demonstrate its therapeutic benefits with safety and effectivenessunder the development of controlled clinic trials.
Fourth. To stimulate the creation of Standardized Operative Procedures, according togood clinical practices for each procedure, taking into account knew developments, withthe view to increase the quality and make homogeneous diverse treatments.
Fifth. To make systematic efforts to ensure that each scientific congress/meeting to beorganized adopts conclusions that reflect the progress made and set achievable andrealistic targets, sharing the findings and aims to encourage and promote research to
deepen the understanding of ozone therapy. To work towards the harmonization andunification of criteria at the international level among different scientific societies.
Sixth. To encourage the different associations to work in their own countries where theozone therapy has not yet been regularized to get it properly regularized and therefore to
enjoy a legal status.
Seventh. To encourage the preparation of text books, the organization of theoreticalcourses and practical training on ozone therapy, so that those who practice it do sobased on sound knowledge; this will necessarily be reflected on a more efficient
medical health care which will benefit the patients.
The speakers at the "International Meeting of Ozone Therapy Schools" as well as theparticipants associations at the same have adopted the following

RECOMMENDATION
That the "Therapeutic Ranges for the Use of Ozone” as detailed in the annex to this“Madrid Declaration” and an integral part thereof, serve as a reference to ozone
therapists in order for them to implement them carefully and systematically.
These "Therapeutic Ranges for the Use of Ozone” are the summary of scientificresearch in different countries and are the result of many years of experiential and2clinical practice.
The speakers at the "International Meeting of Ozone Therapy Schools" as well as theparticipants associations at the same
We express our most sincere recognition to Dr. Velio Bocci, Emeritus Professor of
Physiology at the University of Siena, for the significant and important contributions he
has made in favor of ozone therapy in the fields or research, teaching, information andpatient care, to the point that within the ozone therapy history he must be considered as
one of its most important pioneers.
Finally we express our gratitude to the Spanish Association of Medical Professionals
in Ozone Therapy (AEPROMO) for its initiative and implementation of this"International Meeting of Ozone Therapy Schools" warmly housed in the centenarian
walls of the Royal National Academy of Medicine in Madrid.
Madrid, June 4, 2010

ANNEX TO THE MADRID DECLARATION ON OZONETHERAPY WHICH IS INTEGRAL PART THEREOF
Recommendation approved at the "International Meeting of Ozone Therapy Schools"
held at the Royal Academy of Medicine in Madrid on the 3rd and 4th of June, 2010,
under the auspices of the Spanish Association of Medical Professionals in Ozone
Therapy (AEPROMO)

THERAPEUTIC RANGES FOR THE USE OF OZONE
1. THERAPEUTIC BASIS
Ozone therapeutic indications are based on the knowledge that low physiologicalconcentrations of ozone may play important roles within the cell. At molecular level,
different mechanisms of action have been shown that support the clinical evidence forthis therapy.
There are therapeutic, non effective, and toxic concentrations, of ozone. It has been
proved that concentrations of 10 or 5 µg/ml and even smaller, have therapeutic effects
with a wide security margin, so it is now accepted that the therapeutic concentrations
range from 5 to 60 µg/ml. This range applies to local and systemic application
techniques.
It should be emphasized that each route of application has a minimum and a maximum
dosage as well as concentration and volume to manage.
All the therapeutic dosages are divided into three types, according to their mechanism ofaction:a) Low doses: These doses have an immunomodulatory effect and are used inthose diseases where there is suspicion that the immune system is compromised.

3b) Medium doses: They are immunomodulatories and stimulate the antioxidant
enzyme Defence System. They are most useful in chronic degenerative diseases
such as diabetes, atherosclerosis, COPD, Parkinson syndrome, alzheimer, andsenile dementia.
c) High doses: They are employed especially in ulcers or infected injuries. Also
they are used to ozonize oil and water. The ozonization of oils never can beproduced with a medical generator because it cannot be avoided that oil steam
diffuse in the high-voltage pipes. ¡The result is the production of several very
toxic substances! Except in the generators with valve that cuts the exit of ozone.

2. OZONE THERAPY BASIC PRINCIPLES
The three basic principles that must be taken into account before any ozone treatment
process is implemented are the following:a) Primum non nocere: Before anything else, not to do any harm.
b) Stagger the dose: Start always with low doses, and increase them gradually.
The exception will be in infected ulcers or injuries, where the reverse will beapplied (start with a high concentration, and diminish it according to theimprovement in the patient’s condition).
c) Apply the necessary concentration: Higher ozone concentrations are notnecessarily better, in the same way that it occurs with all the medicines.
Should the redox balance not be known (antioxidants/pro-oxidants) and the patient is inan oxidative stress, an initial medium or high dose, may damage cellular antioxidant
mechanisms and aggravate the clinical picture. It is therefore preferable to start with low
doses and to phase in the increase according to patient response.

3. MAIN ROUTES OF APPLICATION
Medical ozone can be applied locally or parenterally. The various routes of applicationof ozone can be used alone or combined, in order to attain a synergistic effect.

3.1 RECOMMENDED ROUTES OF APPLICATIONThe routes of application described below are safe and proven because they are theresult of many years of experience and research.
We welcome the therapeutic range indicated by the guidelines of the Russian Ozone
Therapy Association, published in its "Handbook of Ozone Therapy" (2008); the"Guidelines for the Use of Medical Ozone" published by the German Medical Society
for the Use of Ozone in Prevention (2009); the guidelines published by the Ozone
Research Centre, scientific unit of the Cuban National Centre for Scientific Research, in
its book "Ozone Basics Aspects and Clinical Applications" (2008); and the significant
contribution from Dr. Velio Bocci in "Has Oxygen-Ozone Therapy a Future in
Medicine? (Rev. 2010) and sent by the author to this "International Meeting."4

Routes ofapplication
RI*
MAHT**
MiAHT***

Application
RoutesRI*
MAHT**
MiAHT***

Application
RoutesRI*

MAHT**
MiAHT***

LOW

LOW

LOW

Conc. µg/ml
10
20
10
20
5
10

Vol. ml.
100

Doses µg
1000
2000
500
2000
25
50

MEDIUM

MEDIUM

MEDIUM

Conc. µg/ml
20
30
20
30
10
20

Vol. ml.
100
150
50
100
5

Doses µg
2000
4500
1000
3000
50
100

HIGH

HIGH

HIGH

Conc. µg/ml3060*aVol. ml.
150
30-50

Doses µg
4500
18000-3000

35
60**b
10
20

50
100
5

1500
6000
50
100

50
100
5

* RI: Rectal insufflation.
Bear in mind that major concentrations of 40 µg/ml can hurt the enterocite.
*a Exceptionally, in case of acute bleeding, begin with a high concentration (60 µg/ml / ml and 50 ml
Vol.) Once the bleeding diminishes, reduce concentration.
** MAHY: Major Autohemotherapy*** MiAHT: Minor Autohemotherapy**b Although in general is preferred to employ concentrations around 40 µg/ml, in some cases it
could be assessed the employment of until 60 µg/ml which has proved to be safe and with greater
capacity of induction of citoquines.

3.1.1 Major Autohemotherapy (MAHT)
The rank of volumes to use varies between 50 ml and 100 ml. Blood volumes greaterthan 200 ml must be avoided to prevent any risk of hemodynamic disturbances,
especially in elderly or unbalanced patients. The perfusion set to be used must be
certified and never should be made of PVC or other materials that react to ozone.

5Ozone concentrations of 80 µg/ml and above, should also be avoided because of theincreased risk of haemolysis, reduction of 2, 3 DPG and a consequent inability ofactivating immunocompetent cells.
The number of treatment sessions and the ozone dosage administered will depend on thepatient's general condition, age and main disease. As a general rule, every five sessions
the dose of ozone is increased and it is given in cycles that vary between 15 and 20
sessions. From the clinical point of view the patient's improvement occurs between thefifth and tenth session, and it is considered that after the twelfth session the antioxidant
defense mechanisms are already activated. The treatment is given in a cycle that is
administered daily, from Monday to Friday and also could be administered two to threetimes a week.
3.1.2 Intramuscular, paravertebral and intrarticular injection
3.1.2.1 Paravertebral
The infiltration is made 2 cm lateral from the spine/column. The distribution of theneedles is always bilateral, lateral or 2 cm. above and 2 cm below the hernia.
A depth from 2 to 4 cm should be considered when taking into account the patient’s
constitution and/or the area to be treated (smaller in thin patients and in dorsal region
and greater in obese patients and lumbar region).
The treatment is done twice a week for the first two weeks and once clinicalimprovement is achieved, the treatments are spaced to once a week for four to six weeks
and then one session every 15 days until one cycle of 20 sessions is completed, thesecan be shortened once the symptoms have disappeared. The recommended needle sizes
for this procedure is 25 to 30 G x 1½”. In some cases and with expert hands, longer
needles may be used.
It is important that the physician examines adequately the muscles within the lumbo
sacra region and the sacro iliac articulations to detect inflammation at this level or“trigger points" in that zone, above all in patients with discartrosis that do not respondadequately to the paravertebral infiltrations. If these points are detected they must be
infiltrated.
Concentration [µg/ml] 10-20
Volume / ml 5-10
Dose / µg 50-400
3.1.2.2 Hernias
Cervical hernias
Concentration of 10 and 20 µg/ml, a volume of 5 ml is given.
Dorsal Hernias
Concentration of 10-20 µg/ml, a volume of 5 ml is given.
Lumbar Hernias
Concentration of 10-20 µg/ml, a volume of 5-10 ml is given.
3.1.2.3 Intraarticular treatment
Concentration: 5-10-20 µg/ml
Volume in function of the articulation size:

6

Fingers: 1-2 ml
Rest: 5 - 20 ml
3.1.2.4 Intradiscal Treatment
In general only one intradiscal infiltration should be performed, although it could be
repeated within 2 - 4 weeks, under mobile radiologic arch or fluoroscopic control or CT.
The patient has to be under sedation (no general anaesthesia) and with an antibiotic
prophylactic therapy the same day of the procedure.
For lumbar discolisis a 5-10 ug/ml mixture of oxygen - ozone at a concentration of 2530 ug/ml is used. For cervical discolosis 5 ml with the same concentration. The
discolisis with ozone, although is effective after only one treatment, it requires specificinfrastructure (for radiological control), anaesthetist and experienced personnel in theexecution of the technique. Despite the fact that the paravertreval technique requires
more sessions, it is equally effective and has a minimum level of risk.
3.1.2.5 Peridural treatment (translaminal)
An infiltration is performed in the peridural space, twice weekly previous identificationof the peridural space. It uses a mixture of oxygen-ozone in a volume of 5 ml at aconcentration of 20 ug/ml.
The translaminal peridural method or through the sacred hiatus route is an alternative toconsider in the treatment of hernial disc with ozone therapy, despite being an indirect
method in relation to the intradiscal method because:• With this method, neither the operator is exposed to the risk of undergoingradiation nor the patient.
• Upon deposit of the gas in the peridural space at the level of the conflict zone
disco-radicular, the same acts over both the disk and the damaged root.
• It is easy to perform, causing no neurological damage and incorporating thepatient to his/her normal life soon.
• It requires few material resources and equipment which makes it a lessexpensive and effective method.
• It requires fewer sessions compared to the paravertebral method as an indirect
method.
• It is very useful in the presence of multiple disc hernias.
• The success rate frequency is above 70%.
• It requires a minimum time to recover.
• It can be performed in patients with major associated diseases.
In any case, the three commented techniques require of strict asepsis and sterility
measures and of an inform written consent.
3.1.3 Ozone Bag
Concentrations of 60 - 40 - 30 - 20 µg/ml, are used for periods of 20 to 30 minutes,
depending on the stage and evolution of the lesion. It can use 60-70 µg/ml only inpurulent infections. Once the infection is controlled and the healthy granulation tissue
appears, the procedure is to reduce the concentration and to space the sessions in orderto support the healing.

73.1.4 Subcutaneous application
The concentration of ozone used is 5 to 10 µg/ml in very small volumes of gas (1-2 ml)with a 30 G needle.
It is also efficient in the treatment of neuropathic pain. Can also be used for cosmetic
purposes in cellulite, never using a volume larger than 100 ml per session.
3.1.5 Ozone Bell or Ventosa
Using concentrations ranging from 15 to 60 µg/ml, with a variation in the duration of
the treatment between 15 to 20 minutes.
3.1.6 Insufflation in fistulas
Always the practitioner must be sure first that not communication with the respiratory
tract exists. It is important to keep in mind the possible gas build-up in a closed cavity,
blocked or cystic to avoid dangerous or painful increases in pressure, for example incutaneous, perianales and surgical fistulas.
3.1.7 Ophthalmologic
In ophthalmological cases (queratitis, corneal ulcers, conjunctivitis and ocular burns), a
special glass attachment adapted to the contour of the eye is used. Anesthetic eye drops
are applied previously and a concentration of ozone between 20 and 30 µg/ml during 5
mn. Two to three applications per week can be made combined with subconjunctival
application of ozone, at a concentration of 35 µg/ml with a volume of 1-2 ml.
3.1.8 Vaginal Insufflation
Ozone concentrations of 20-40 µg/ml and a volume between 1000-2000 ml at acontinuous flow rate of 0,1 to 0,2 l/min for 10 min. are used. A vaginal wash withozonized water must be carried out previously. For this application an ozone destructor
device is required.
3.1.9 Insufflation vesicourethral
Insufflate between 50 and 100 ml of ozone into the bladder or urethra, according to thecase to be treated. The recommended concentrations are from 10-15-20 and 25 µg/ml(increasing them progressively). The treatment could be combined with a pre-irrigation
procedure with ozonized water.
3.1.10 Otic route
The external ear is moistened and then it is insufflated using a syringe or a special
headset with an ozone destructor device. Check that the eardrum is intact.
Concentrations between 20-30 µg/ml during 5 mn are used.
3.1.11 Intratonsilar route
It is a secure route in patients older than 12 years old, with the condition that they can
actively cooperate when they are asked to hold their breath (apnea) meanwhile themedical ozone injection is applied. Concentrations of 15-20 µg/ml with a volume of 2.5
ml per point to infiltrate at the anterior and rear pillar of both tonsils are used. Four tofive sessions are required.
3.1.12 Ozone micro doses in trigger points and acupuncture
As a general rule the trigger points are located in the muscles and often deeply, so the8application has to be intramuscular and the volume can be between 5-10 ml dependingon the anatomical place, and, the concentration between 10 and 20 mcg/ml.
For acupuncture points or reflexology areas the application is intradermal and fluctuates
between 0.1 to 0.3 ml and up to 1 ml (maximum) of the gas mixture of O2-O3 withconcentrations below 30 µg/ml.
3.1.13 Topical application of water, oil and ozonized creams
It is applied on wounds, ulcers and several infected lesions at different concentrations:high, medium, and low, depending on what it is intended to achieve (to disinfect, toregenerate) and of the type of tissue where it will be applied.
3.1.14 Ozonized Saline Solution
The rank of concentrations of ozone used in the phase of gas (from the ozone
equipment) is of 500 mcg/l to 5000 mcg/l.
The ozonization is carried out with very low ozone concentrations which are calculated
according to the weight of the patient. The formula used is 25 mcg by 1 kg of patient’s
weight. For example: if the patient weighs 80 kg, it is multiplied as follows: 80 x 25 =2000 mcg (2 mcg/ml or 2 mg/l).
This figure corresponds to the concentration generated by the equipment, which is very
low and it does not reach the 2,0 mcg/ml. Under this method concentrations generated
by the ozone equipment above 3,000 mcg/l are never used.
The procedure consists of:• To bubble 200 ml of saline solution at 0,9% during 10 mn, time necessary toobtain an adequate saturation of the solution that goes from 20 µg/ml until 200µg/ml of concentration.
• To initiate then the transfusion of the solution by drip to the patient during 25-30
mn, keeping a constant bubbling of ozone in the bottle, to maintain its
concentration in the solution.
• To cut the bubbling and the transfusion at the 150 ml, leaving in the bottle 50 mlof solution as safety margin.
• Nowadays, an ozone equipment that maintains the ozone concentration in thesolution without needing to maintain the bubbling during the transfusion isavailable.
3.1.15 Pediatrics dosages through rectal insufflation
Systemic application via, only by via rectal.
• The concentrations to be used depend on the grade of the oxidative stress of thepatient and the pathology to be treated.
• The volume to be administered depends on the age of the patient.
• To perform the rectal insufflation a catheter is introduced 1-2 cm inside the anal
sphincter.

93.1.15.1 Dosages for patients with an initial value of oxidative stress graded “0” or“1” (Light one)
Weeks oftreatment

Concentration O3(µg/ml)First

20

Second

25

Third

30

Fourth35

3.1.15.2 Dosages for patients with an initial value of oxidative stress graded “2” or“3” (Moderated)
Weeks oftreatment

Concentration O3(µg/ml)First

15

Second

20

Third

25

Fourth30

3.1.15.3 Dosages for patients with an initial value of oxidative stress graded “4”(Severe)Weeks oftreatment

Concentration O3(µg/ml)First

10

Second

15

Third

20

Fourth25

3.1.15.4 Volumes to be administered according to patient’s age
Age of the patient
28 days-11 months
1 -3 years
3-10 years
11-15 years

Volumes to beadministered
15-20 cc
20-35 cc
40-75 cc
75-120 cc

10The dosage changes every five sessions. Cycles of 15-20 sessions are indicated every
three months during the first year. Later the patient will be evaluated to determine
frequency of the cycles for the second year.
3.1.16 Ranges of diseases for rectal insufflation and major autohemotherapy
applications
3.1.16.1 LOW RANGE• Biological regeneration• Gout• Fibromyalgia
3.1.16.2 LOW-MIDDLE RANGE• Chronic kidney failure• Cancer• Nephropathies
3.1.16.3 MIDDLE RANGE• Neurovegetatives illnesses: Alzheimer, parkinson, dementia syndromes.
• Pulmonary illnesses: Emphysema, COPED, acute respiratory distress syndrome.
• Ophthalmological illnesses: Retinosis pigmentarias, cataract, glaucoma, maculardegeneration related to age.
• Hematology illnesses: Thalassaemia B, scklemia. • Vascular Illnesses: HTN,
venous insufficiency, peripheral arterial illness, CVA, cardiacs ischemia, veined
stasis.
3.1.16.4 MIDDLE-HIGH RANGE• Viral Illnesses: Herpes simple, herpes zoster, AIDS, hepatitis A, B, C,
papilloma human virus.
• Diabetes• Cerebral palsy• Dermatological illnesses• Orthopedic illnesses• Giardiasis• Candidiasis and cryptosporidiosis.
• Allergic illnesses• Chronic fatigue syndrome• Lupus Erythematosus Systemic• Rheumatoid arthritis• Crohn’s illness• Intestine inflammatory illnesses• HIV/AIDS• Multiple sclerosis

3.2 APPLICATION ROUTES NOT RECOMMENDED FOR NOT
BEING SAFE
3.2.1 Direct intravenous injection of ozone
Its application is strongly discouraged due to the risk of air embolism which can occur

11even in the case of using an slow infusion pump and volumes of 20 ml. The
complications of stroke range from a simple axillary bubbling sensation, then cough, afeeling of retrosternal weight, dizziness, to changes in vision (ambioplia), hypotensivecrisis, with signs of cerebral ischemia (paresis of the members) and death.
Furthermore, there is no justification to put the patient and the therapy at risk when
there are methods that are safe, have been tested and are effective such as the major
autohemotherapy, minor autohemotherapy and rectal insufflation.
3.2.2 Vitamins and ozone
During the treatment with ozone is necessary to suspend all the antioxidant supplementsthat contain vitamin C and vitamin E. The presence of these compounds in highconcentrations in the blood, interferes with the ozone’s action as an oxidant agent andtherefore the good course of the therapy. It is important to communicate to the patientthat s/he must not consume excessive quantities of foods very rich in these vitamins. In
consequence, the vitamins or antioxidants should be given before or after the ozone
therapy but never during the treatment.

3.3 APPLICATION ROUTE ON ANIMAL EXPERIMENTATIONPHASEIntraperitoneal
This route is still in the scientific experimental phase in animals, to which various tumor
cell lines have been implanted, having found that ozone is more cytotoxic to tumor cells
than many of the cytostatics used, without causing the adverse effects of thechemotherapy. The research into this matter is being undertaken by the Veterinary
Services and Laboratory Animal Medicine of the Philipps-University of Marburg(Germany) by Medical Veterinarian Professor Siegfried Schulz.
It is exhorted that investigations in animals continue to be carried out.
Experimental studies for the treatment of cancer in human beings have not yieldedconvincing data so far.
In human beings has been used for peritonitis´ treatment applying a peritoneal washwith ozonized water using 200 to 300 ml in volume with a concentration between 10
and 20 µg/ml, through a silicone catheter fixed into the cavity.

3.4 APPLICATION ROUTE PROHIBITTED
Inhalation route
The inhalatory route is absolutely prohibited because of being highly toxic. The
anatomical and biochemical characteristics of the lung make it extremely sensitive tooxidative damage by ozone.

3.5 APPLICATION ROUTE THAT HAS NOT RECEIVED TOTALCONSENSUS
Ozonized Saline Solution
The Ukrainian and Russian schools utilize it as another form of systemic application of
the ozone and its practice is well extended in those two countries. Its efficiency is12testified by the results of the scientific research submitted at the eight Practical
Scientific Conferences that have taken place in Russia from 1992 to 2009.
Nevertheless this methodology still has not found the consensus between some schools
and it is left to the criteria of the doctors whether or not to use this method.

3.6 ESSENTIAL REQUIREMENTS
The described routes of application require of technically qualified personnel to carryout any procedure, as well as a written informed consent, followed by strict measures of
asepsis and sterility.
As with any another medical practice, all the material used in ozone therapy that be incontact with patient’s tissue or fluids must be either disposable after only one use, or besterilized (ex. surgical equipment), and before the administration of the ozone must passan antimicrobial sterile filter <of 20 µm.

4. PATHOLOGIES MORE APPROPRIATE TO BE TREATED WITHOZONE THERAPY
The diseases sensible to the ozone treatment may be classified into three categories,
based on the therapeutic success grade proved and obtained.
4.1 Diseases in the first category
These include among others:a) Osteomyelitis, pleural emphysema, abscesses with fistula, infected wounds, bed
sores, chronic ulcers, diabetic foot and burns.
b) Advanced ischemic diseases.
c) Related to age, macular degeneration (atrophic form) because the orthodox
ophthalmology gives no significant treatment.
d) Orthopedic diseases and localized osteoarthritis.
e) Chronic fatigue syndrome and fibromyalgia.
f) Dental injury-related to primary cariogenic lesions, particularly in children.
g) Estomatology for chronic and recurrent infections in the oral cavity.
h) Acute and chronic infectious diseases, particularly those caused by bacteria resistantto antibiotics or to chemical treatments, viruses, fungi (hepatitis, HIV-AIDS, herpes andherpes zoster infection, papillomavirus infections, onichomicosis and candidiasis,
giardiasis and cryptosporidiosis). Bartolinitis and vaginal candidiasis.
Although the ozone therapy represents a useful support for the treatment of these
diseases, it is worth to underline that neither the ozone nor its metabolites, among themthe H2O2, reach a germicide tisular concentration, because the free pathogens areprotected by plasma antioxidants and intracellular viruses are unattainable.
For these pathologies the ozone therapy either used only as exclusive form or as asupport for a specific treatment, according to the cases, becomes a medicine/treatment
with a high therapeutic success.
4.2 Diseases in the second category
These include:a) Cancer-related fatigue. The ozone therapy associated with orthodox treatments, may

13

accelerate and improve results. However, ozone therapy has so far not been able toshow a therapeutic effect on cancer. For all these pathologies ozone treatment should be
integrated with the conventional treatment, there is evidence of its utility, but more
precise studies are requiredb) Asthma.
4.3 Diseases in the third category
Among others include:a) Autoimmune diseases (multiple sclerosis, rheumatoid arthritis, Cohn’s disease)b) Senile dementiac) Lungs diseases: emphysema, chronic obstructive pulmonary disease, idiopathic
pulmonary fibrosis and acute respiratory distress syndrome.
d) Skin diseases: Psoriasis and atopic dermatitis.
e) Cancer metastasisf) Severe sepsis and multiple organ dysfunction.
In these cases the combination of orthodox treatments and ozone therapy, at least on
theoretical grounds, show that it may be useful but there is no real clinical evidence.
The anecdotal evidence suggests the existence of therapeutic effectiveness but, in manycases the efficacy has been achieved by using various types of therapy, therefore theresults are not reliable. In some studies the combination of ozone therapy with anothertreatment has been evaluated, concluding that ozone therapy acts as complement.

5. GENERAL BASIS FOR TREATMENT
Not all patients respond equally to the small, controlled oxidative stress that is producedby the ozone therapy. Therefore, the ozone treatment should always be applied in a
gradual and progressive manner, starting with low doses and increasing it gradually to
avoid unnecessary risks, until a clinic diagnostic method for the oxidative stress isavailable, which allows to adjust the dose.
It is advisable to measure and classify the state of oxidative stress on the patient, using
markers such as malon-aldehyde, catalase, superoxide dismutase, glutathione
peroxidase and indicators of the total antioxidant activity in the medical cabinet.
If it is not possible to measure the oxidative stress degree of the patient by either of theestablished methods, it is very important that the physician value according to theclinical state of the same, if he is eligible or not to receive the treatment with ozone atthat moment, or if it is necessary to improve his/her nutritious state first.
As with any medical treatment, patients may be divided into three types:
Normo-responders, hyper-responders and hypo-responders.
There are factors which can not be controlled, that depend of the patient’s idiosyncrasy
and the characteristics how the disease manifests itself.
Ozone therapy is a “medical act” and should be practiced by medical personnel andimplemented with a scientific rigor, it can produce with a low frequency a minimum ofadverse cases. Is for this reason that we consider that the regularization of the ozone
therapy carried out by the authorities should include the following requirements, and in
those cases where this has not been done the ozone therapists should apply them,

14

The medical centers where the ozone therapy is practiced should have the mandatory
sanitary authorization for its functioning and should abide by the following
requirements:
5.1 To have a qualified doctor with training and recognized experience in ozone
therapy, this will be the persona responsible for the management of the treatment.
5.2 To use the appropriate equipment to generate and apply the ozone therapy, theseshould have also the required authorizations from the appropriate sanitary authorities. In
the case of the European Community, should be marked with the CE. The equipment togenerate ozone must be calibrated or revised periodically, according to therecommendation of the manufacturer, to avoid incorrect applications or concentrations.
5.3 To use medical oxygen provided by an authorized company.
5.4 To implement the various and appropriate protocols, according to the administrationroute chosen, in order to guarantee the quality in the treatment. The protocols should beappropriately validated and recognized by the scientific ozone therapy associations.
5.5 To establish an informed written consent, this should be signed by the patient andthe medical doctor responsible for the implementation of the ozone therapy, leaving a
copy in the clinical history of the patient.
5.6 To have an appropriate airing and ventilation system.
5.7 To have life saving drugs, ventilation support equipment or an Ambu balloon.
5.8 To take into account that the inter disk application of ozone should be done in asurgical room within a hospital centre or in an ambulatory unit for major surgery.
5.9 The key to the therapeutic success depends on diverse controllable factors that
include the scientific preparation and technique of the ozonoterapist, the method that is
employed, the quality of the ozone, the general application of the good clinicalpractices. The non controllable factors depend on the patient idiosyncrasy and in what iscurrent state of the illness.
Madrid, June 4, 2010
ARGENTINA(Signed) Dr. Ana Elizabeth Rieck (MD).
President, Inter American Society of
Oxygen Ozone Therapy.
CUBA(Signed) Professor Mirta Copello (MD).
Retinitis Pigmentosa National ReferenceCentre. “Dr. Salvador Allende” Hospital.
Havana.
(Signed) Dr. Vivian Borroto Rodríguez
(MD). National Center for Natural andTraditional Medicine, Havana.

(Signed) Professor Luisa Batilde Lima
Hernández (Biochemistry andNutritionist). National Center for Naturaland Traditional Medicine, Havana.
(Signed) Dr. Agne Esther Diaz Riverol(MD). Paediatric Hospital, Sancti Spíritus.

EGYPT(Signed) Professor Nabil Mawsouf(MD). Director of the Unit of Pain,
University of Cairo.

15

GERMANY(Signed) Dr. Renate Viebahn-Haensler,(Bio-Chemistry, Pharmacology). General
Secretary of the German Medical Society
for the Use of Ozone in Prevention and
Therapy and the European Cooperation of
the Medical Ozone Societies.
ITALY(Signed) Professor Velio Bocci (MD).
Emeritus Professor of Physiology at the
University of Siena.
(Signed) Dr. Anna María Procopio(MD). Paediatrician.

MEXICO(Signed) B.S. Carla Núñez Lima
(Biochemistry). Culiacán, México

(Signed) Dr. med. vet. Siegfried Schulz.
(Veterinary Surgeon). Veterinary Services
and Laboratory Animal Medicine of thePhilipps-University of Marburg.

(Signed) Professor Lamberto Re (MD).
Professor, Clinical Pharmacology and
Toxicology, University of Ancona.
(Signed) Professor Gregorio Martínez
Sánchez (Pharm. Dr., Senior Researcher).
Scientific Director, Medinat srl. Ancona.

(Signed) Dr. Froylán Alvarado Güémez,MD. President of the Mexican Associationof Ozone Therapy.

(Signed) Dr. Jaime Rebeill Félix (MD).
Director, Pain and Spine Clinic,
Hermosillo (Sonora), México.
ROMANIA(Signed) Dr. Tiron Stefan (MD).
President Founder, Scientific Romanian
Association of Ozone Therapy.
RUSSIA(Signed) Professor Sergey Peretyagin(PhD). Head of the Department ofExperimental Medicine, Research Instituteof Traumatology and Orthopedics, Nizhny
Novgorod; President of the Russian
Association of Ozone Therapy.
SPAIN(Signed) Dr. Adriana Schwartz (MD).
Director, Clínica Fiorela, Madrid.
President of the Spanish Association of
Medical Professionals in Ozone Therapy(AEPROMO); President of theInternational Medical Ozone Federation(IMEOF); Vice-President of the AsianEuropean Union Ozone Therapists.

(Signed) Professor Claudia N.
Kontorschikova (PhD) Head of
Department of the Clinical Diagnostic
Laboratory, Medical Academy, Nizhny
Novgorod.

(Signed) Dr. Bernardino Clavo Varas(MD). Specialist, Radiotherapy Oncology
Department, Great Canary University
Hospital Dr. Negrín.

16

(Signed) Dr. Fernando Kirchner van
Gelderen (MD). Director, Gabinet Mèdic
Maresme, Mataró (Barcelona).
UKRAINE(Signed) Dr. Sci. Eugeni I. Nazarov.
President of the Ukrainian Association
Ozone Therapists, Executive President of
the Asian-European Union Ozone
Therapists.
UNITED STATES(Signed) Dr. Frank A. Shallenberger(MD). Director, Center for Alternative
Medicine, Anti-Aging, Nevada.
Madrid, June 4, 2010
Translated from Spanish into English by Sara Esther Russy King (Nutritionist and Dietician ), Roberto
Quintero (Lawyer) and Fabricio Quintero Schwartz (English teacher).

Associations and Federations of Ozone Therapy that signed the“Madrid Declaration on Ozone Therapy” on June 4, 2010
1. Asian-European Union Ozone Therapists. Executive President: Dr. Sci.
Eugeni I. Nazarov.
2. European Cooperation of the Medical Ozone Societies. General Secretary:
Dr. Renate Viebahn-Haensler.
3. Inter American Society of Oxygen Ozone Therapy. President: Dr. Ana
Elizabeth Rieck.
4. International Medical Ozone Federation (IMEOF). President: Dr. Adriana
Schwartz.
5. German Medical Society for the Use of Ozone in Prevention and Therapy.
General Secretary: Dr. Renate Viebahn-Haensler.
6. Mexican Association of Ozone Therapy (AMOZON). President: Dr. Froylán
Alvarado Güémez.
7. Russian Association of Ozone Therapy. President: Professor Sergey
Peretyagin.
8. Scientific Romanian Association of Ozone Therapy. President: Dr. Tiron
Stefan.
9. Spanish Association of Medical Professionals in Ozone Therapy(AEPROMO). President: Dr. Adriana Schwartz.
10. Ukrainian Association Ozone Therapists. President: Dr. Sci. Eugeni I.
Nazarov.

Associations and Federations of Ozone Therapy that signed the“Madrid Declaration on Ozone Therapy” after June 4, 2010
11. Belarus Association of Ozone Therapists. President: Dr. Gennady Mitelsky.

1712. Brazilian Association of Ozonetherapy (ABOZ). President: Dr. Ana Cristina
Barreira.
13. Dominican Association of Ozone Therapy. President: Dr. Antonio Contreras
Berroa
14. Ecuadorian Society of Ozone Therapy. President: Dr. Danilo Ruiz Reyes.
15. Egyptian Medical Society for Ozonetherapy and Complementary Medicine
Development. President: Prof. Nabil Mawsouf.
16. Georgian Association of Ozone Therapists. President: Dr. Vladimir
Talakvadze.
17. Italian Federation of Ozone Therapy. Secretary: Professor Matteo Bonetti.
18. Japanese Society of Oxidative Medicine. President: Dr. Takeo Watarai.
19. Lithuanian Association of Ozone Therapists. President: Dr. Valentin
Zhurbenko.
20. Moldavian Association of Ozone Therapists. President: Dr. Aleksandr Bulat.
21. Turkish Medical Ozone Therapy Association. President: Dr. Murat Bas.
22. Venezuelan Association of Ozone Therapy (SOVEOT). President: Dr. Sergio
Viti Paganelli
23. World Federation of Oxygen-Ozone Therapy. Secretary: Professor Matteo
Bonetti.
Madrid, April 16, 201118