Medical ozone: Definition, concentration range, production, measurement.
(Guidelines ozone therapy*:

Medical ozone, an ozone/oxygen mixture consisting of purest O2 and purest O3, is produced from medical oxygen (in accordance with pharmaceutical legislation) using a medical ozone generator (Medical Devices Directives: 92/43EEC or equivalent directives in non European countries) in a

concentration range between 1 and 100 µg/ml (mg/l).

Ozone is a metastable substance and has to be produced on site. Continous concentration measurements are a prerequirement for a safe therapy.


When used in specific diseases and conditions, medical ozone produces the same or similar therapy results worldwide. Improper application in the form of erratic methods and doses is the most frequent cause of ineffectiveness and adverse effects – and always the cause of violent controversies.

For this reason, the medical societies for ozone application have set up treatment protocols as basis for standards and guidelines, revised and published as a result of the most recent research and 30 years of experience (Beck, Wasser, Viebahn1998; Knoch, Viebahn 2009; Viebahn, León, Fahmy 2012). They are here made full use of in the standardization of applications, indications, concentrations, doses and frequency of treatment as based on the mechanism of action and the pharmacology of ozone.


In its pharmacological effect, medical ozone follows the principle of hormesis: low concentrations (or doses) show a high efficacy, which decreases with increasing concentration, finally reversing into a questionable and even toxic effect. Figure 1 shows the effect/concentration relationship for the systemic application of ozone – in the form of a standardized major ozone autohemotherapy and rectal ozone gas insufflation – in schematic form: Concentrations of 10 – 40 µg ozone / ml ozone/oxygen mixture represent those levels which are physiologically effective and recommended for systemic application.

In the high concentration range of 60-100 µg/ml the antibiotic effect of ozone has a wide range of applications in the treatment of infected wounds, diabetic foot, decubitus ulcers and burns, but completely restricted to the topical forms of application.


Principally, ozone is applied complementary to a corresponding basic therapy.

Diabetes, Type 2 diabetes, chronic inflammatory diseases such as inflammatory vascular disease, in particualr diabetic angiopathia, chronic hepatitis forms and chronic intestinal conditions belong to the classic indications within the low-dose ozone concept.

Chronic oxidative stress (pathologically increased values for malone dialdehyde MDA, hydrogen peroxide H2O2, total hydroperoxide TH etc.) and an antioxidant deficit (disbalanced superoxide dismutase and subgroups of SOD as well as catalase CAT and others) are phenomena common to all the above diseases. It is here in particular that loe-dose ozone as a hormetic substance, shows a regulatory effect on pathological processes.