Biodegradable antibiotic delivery systems

Abstract

Bacterial infection in orthopaedic surgery can be devastating, and is associated with significant morbidity and poor functional outcomes, which may be improved if high concentrations of antibiotics can be delivered locally over a prolonged period of time. The two most widely used methods of doing this involve antibiotic-loaded polymethylmethacrylate or collagen fleece. The former is not biodegradable and is a surface upon which secondary bacterial infection may occur. Consequently, it has to be removed once treatment has finished. The latter has been used successfully as an adjunct to systemic antibiotics, but cannot effect a sustained release that would allow it to be used on its own, thereby avoiding systemic toxicity. This review explores the newer biodegradable carrier systems which are currently in the experimental phase of development and which may prove to be more effective in the treatment of osteomyelitis.

Antibiotic and chemotherapeutic enhanced three-dimensional printer filaments and constructs for biomedical applications

“…21,22 Additionally, further antibiotic release during degradation could increase antimicrobial efficacy when compared with non-biodegradable carriers. [23][24][25] Systemic delivery of antibiotics affects the intended site as well as surrounding uninfected tissues, and for some patients, carries risks of hepatocytotoxicity and nephrotoxicity, and has the potential to increase antibiotic resistance. It is clinically advantageous to have direct treatment without unnecessary and widespread harmful effects.…”

New Antibiotics in the Therapy of Osteomyelitis

“…The topical application allows very high local concentration without systemic side effects. 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] .…”

Choice of an Agent for the Topical Treatment of Infected Wounds

“…Однако, если антибиотик для местного применения не использует-ся системно, риск роста резистентности значительно снижается [9,17]. Например, бацитрацин и мупиро-цин, обладая достаточной широтой антибактериаль-ного спектра, не используются системно, что делает их практически идеальными препаратами для местно-го использования при ИКМТ [18,19]. Местное при-менение комбинации бацитрацина и неомицина не приводит к абсорбции данных препаратов даже при поврежденной коже и слизистых.…”

“…В теории с уве-личением площади и кратности нанесения таких пре-паратов увеличивается и риск системного действия [20][21][22]. И хотя подобных исследований не проводи-лось, хирурги в амбулаторных условиях не используют местные антибактериальные препараты на больших площадях (более 10 % поверхности тела) [15,19]. В по-добных ситуациях приоритет имеют растворы анти-септиков с их неселективным действием на флору [4].…”