The low-dose ozone concept with its moderate oxidative stress represents an ideal hormesis strategy. Dose-response and concentration-effect relationships in the context with specific applications allow one to fix concentration ranges with therapeutical benefit. Based on the well-known reaction mechanisms of ozone, its biochemical and pharmacological effects, international guidelines have to be defined concerning physiological and ozone resistant materials, indications, applications and the effective concentration and dosage range in dependence on the specific indications. Following the international regulations of ozone concentrations outdoors and indoors, as working site concentrations by WHO (World Health Organization) and in conformance with the Medical Device Directives (MDD) for quality assurance and control, some European Medical Societies for the Use of Ozone have set up a draft for the essential requirements for the treatment procedures, including: (a) production of Medical Ozone; reactivity of O3 and ozone-resistant materials; (b) ozone-free surroundings (WHO regulations) by the integration of effective catalytic systems; (c) ozone-resistant and physiologically indifferent materials used in disposables for MAH, intra-articular, intramuscular and other topical injections (for rectal insufflation, topical treatment as transcutanous gas bath and/or disinfection); (d) medical device directives for safety of the patient; (e) ozone measurement as requirement for concentrations and dosages; and, (f) concentration, dosages, and treatment frequency are listed in dependence on the indication and disease as well as on the underlying mechanism of action.

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Published online 2012