Local Antibiotic Delivery Strategies in Osteomyelitis Treatment
Summary
Osteomyelitis remains a formidable clinical challenge characterised by infection of the bone and marrow, often exacerbated by bacterial biofilms and limited vascular penetration of systemically administered antibiotics. Local antibiotic delivery strategies have been developed to overcome these obstacles by achieving sustained, high‐concentration drug levels at the site of infection, while minimising systemic toxicity. These strategies encompass non-degradable carriers such as polymethylmethacrylate beads or spacers, biodegradable bioceramic and polymeric matrices, and antibiotic-impregnated allografts. Each approach is tailored to manage dead space created by surgical debridement, disrupt biofilm communities on necrotic bone or implants, and support subsequent bone regeneration. Mathematical modelling of release kinetics, optimisation of carrier porosity and degradation rate, and combination therapies that exploit synergistic effects of multiple antibiotics are central to enhancing therapeutic efficacy. By integrating antimicrobial action with osteoconductive properties, contemporary local delivery systems not only eradicate residual pathogens but also contribute to the restoration of structural integrity, thereby reducing the need for repeated surgeries and long-term systemic therapy.
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Local Antibiotic Delivery Strategies in Osteomyelitis Treatment publication trend
The graph below shows the total number of articles in local antibiotic delivery strategies in osteomyelitis treatment across all publications each year (not limited to Nature Index journals).
Technical terms
Osteomyelitis: Infection of bone tissue and marrow, often chronic and difficult to eradicate due to poor vascularity and biofilm formation.
Biofilm: A structured community of bacteria embedded in a self-produced matrix, offering protection against antibiotics and host defences.
Polymethylmethacrylate (PMMA): A non-degradable acrylic bone cement used as a carrier for high local antibiotic concentrations.
Calcium sulphate/hydroxyapatite (CaS/HA): A biodegradable ceramic composite that delivers antibiotics while providing an osteoconductive scaffold.
Elution kinetics: The rate and pattern by which an antibiotic is released from a local carrier into surrounding tissues.
Debridement: Surgical removal of infected or necrotic tissue to reduce bacterial load and create space for local delivery systems.
Carrier graft: A bone or biomaterial scaffold impregnated with antibiotic to fill dead space and support bone healing.
References
- Pharmacokinetic Interpretation of Applying Local Drug Delivery System for the Treatment of Deep Surgical Site Infection in the Spine. Pharmaceutics (2024).
- A calcium sulphate/hydroxyapatite ceramic biomaterial carrier for local delivery of tobramycin in bone infections: Analysis of rheology, drug release and antimicrobial efficacy. Ceramics International (2023).
- Analysis of the Ability of Different Allografts to Act as Carrier Grafts for Local Drug Delivery. Journal of Functional Biomaterials (2023).
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