Local Antibiotic Therapy in Osteomyelitis

Abstract

The local delivery of antibiotics in the treatment of osteomyelitis has been used safely and effectively for decades. Multiple methods of drug delivery have been developed for the purposes of both infection treatment and prophylaxis. The mainstay of treatment in this application over the past 20 years has been non-biodegradable polymethylmethacrylate, which has the advantages of excellent elution characteristics and structural support properties. Biodegradable materials such as calcium sulfate and bone graft substitutes have been used more recently for this purpose. Other biodegradable implants, including synthetic polymers, are not yet approved for use but have demonstrated potential in laboratory investigations. Antibiotic-impregnated metal, a recent development, holds great promise in the treatment and prophylaxis of osteomyelitis in the years to come.

Development of nanoantibiotic delivery system using cockle shell-derived aragonite nanoparticles for treatment of osteomyelitis

“…saidykhan et al lead to systemic toxicity 4,5 without achieving the required concentration at the affected site of infection. 2 A local antibiotic delivery system (LADS) is an alternative treatment approach that has evolved to obliterate the complications associated with the conventional treatment of osteomyelitis.…”

“…Initially, poly(methyl methacrylate) cements or beads were widely used as drug delivery systems, but due to their nonbiodegradability property, they have been slowly succeeded by biomaterials that can possibly partake in bone regeneration and avoid surgical removal. 4,5 A biodegradable antibiotic delivery system seemingly offers a lasting solution to the drawbacks of nonbiodegradable ones. However, since the desired drug release kinetic and bone regeneration are simultaneously difficult to achieve, [7][8][9] designing a biodegradable delivery system becomes more demanding.…”

New Antibiotics in the Therapy of Osteomyelitis

“…Antibiotic-impregnated collagen fleece is widely used in clinical practice and shows higher release rates than PMMA, but shorter elution time [41] . Multiple other biodegradable substances have been developed during the last decades and are currently under investigation [42,43] . Unfortunately, we are unaware of new developments regarding surgical techniques.…”

Technologies Applied to Stimulate Bone Regeneration

“…More recently there was a proposal for the expansion of the clinical use of calcium sulfate as an antibiotic release agent, since it ensures high local concentration of the drug, avoiding its systemic circulation (Gogia et al, 2009). Reports demonstrate the control of osteomyelitis through the application of calcium sulfate pellets with antibiotics such as tobramycin, vancomycin and gentamicin (Bibbo & Patel, 2006;Chang et al, 2007).…”