The Efficacy of Boric Acid Used to Treat Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus: an In Vivo Study

Abstract

We explored the ability of local and systemic applications of boric acid (BA) to reduce the numbers of methicillin-resistant Staphylococcus aureus (MRSA) in a rat model of tibial osteomyelitis (OM), and compared boric acid with vancomycin (V). Implant-associated osteomyelitis was established in 35 rats. After 4 weeks, at which time OM was evident both radiologically and serologically in all animals, the rats were divided into five groups of equal number: group 1, control group (no local application of BA or other medication); group 2, V group; group 3, local BA + V group; group 4, local BA group; and group 5, local + systemic BA group. Serum total antioxidant status, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6, were measured. Pathological changes attributable to bone OM were evaluated using a grading system. Bacterial colony-forming units (CFUs) per gram of bone were counted. The lowest bacterial numbers were evident in group 3, and the bacterial numbers were significantly lower than that of the control group in all four test groups (p < 0.001). Group 3 also had the least severe bone infection (OM score 1.7 ± 1.1, p < 0.05). Upon histological and microbiological evaluation, no significant difference was evident between groups 2 and 3. Total antioxidant levels were significantly different in all treatment groups compared to the control group. Microbiological and histopathological evaluation showed that systemic or local application of BA was effective to treat OM, although supplementary V increased the effectiveness of BA.

Combination of Erythromycin and Curcumin Alleviates Staphylococcus aureus Induced Osteomyelitis in Rats

“…Inflammation is associated with bacterial infection. Previous studies showed that increased inflammation is associated with osteomyelitis (Yoshii et al, 2002 ; Lew and Waldvogel, 2004 ; Guzel et al, 2016 ). Despite of its lacking antimicrobial function in MRSA induced osteomyelitis, we did observe a significant reduction of pro-inflammatory cytokines in rats treated with erythromycin alone.…”

“…In the current study, we successfully established chronic implant-induced osteomyelitis in male Wistar rats as described previously (Lucke et al, 2003 ; Vergidis et al, 2015 ; Guzel et al, 2016 ). Using this model, we studied the effects of erythromycin alone, curcumin alone and erythromycin and curcumin combined treatment against MRSA induced osteomyelitis.…”

“…Adult male Wistar rats weighing 260 g to 340 g were purchased from SLAC Company and housed in Shanghai Jiao Tong University Affiliated Sixth People's Hospital rat facility under standard environment with free access to water and food. The procedures of establishing implant related osteomyelitis were adapted from previous studies (Vergidis et al, 2015 ; Guzel et al, 2016 ). Briefly, experimental rats were anesthetized by intraperitoneal injection of weight adjusted ketamine (60 mg/kg body weight) and xylazine (6 mg/kg body weight).…”

“…Each ROI was assessed by four independent observers, with no access to the animal group codes. Scores were assigned based on the criteria as described in previous studies (Lucke et al, 2003 ; Guzel et al, 2016 ). The following four parameters were scored with 0 (absent) or 1 (present): 1.…”

Co-administration of Erythromycin and Leech Salivary Extract Alleviates Osteomyelitis in Rats Induced by Methicillin-Resistant Staphylococcus aureus

“…The maximum score of one tibia including four examined regions and four mentioned parameters was 24 for each animal as previously described. 28…”