Local Antibiotic Delivery Systems: Current and Future Applications for Diabetic Foot Infections

Abstract

Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease, and it can be the pivotal event leading to a minor or major amputation of the lower extremity. Treatment of diabetic foot infections, especially deep-seated ones, remains challenging, in part because impaired blood perfusion and the presence of biofilms can impair the effectiveness of systemic antibiotics. The local application of antibiotics is an emerging field in the treatment of diabetic foot infections, with demonstrable advantages. These include delivery of high concentrations of antibiotics in the affected area, limited systemic absorption, and thus negligible side effects. Biodegradable vehicles, such as calcium sulfate beads, are the prototypical system, providing a good elution profile and the ability to be impregnated with a variety of antibiotics. These have largely superseded the nonbiodegradable vehicles, but the strongest evidence available is for calcium bead implantation for osteomyelitis management. Natural polymers, such as collagen sponge, are an emerging class of delivery systems, although thus far, data on diabetic foot infections are limited. There is recent interest in the novel antimicrobial peptide pexiganan in the form of cream, which is active against most of the microorganisms isolated in diabetic foot infections. These are promising developments, but randomized trials are required to ascertain the efficacy of these systems and to define the indications for their use. Currently, the role of topical antibiotic agents in treating diabetic foot infections is limited and outside of routine practice.

Therapeutic application of adipose-derived stromal vascular fraction in diabetic foot

“…About one-third of diabetic patients develop a fever when they have a foot infection, but the number of white blood cells may not increase despite widespread infection. However, if the patient has sensory neuropathy, the perception of pain or temperature is weakened, so the perception of infection will be delayed [30]. If the patient's blood sugar cannot be controlled, the infection will be difficult to control.…”

<p>Optimal management of diabetic foot osteomyelitis: challenges and solutions</p>

“…The most recent review on local antibiotic-delivery systems78 concluded that they represent a promising pharmaceutical option in the treatment of DFIs. Well-designed randomized clinical trials are required to establish their efficacy and define the framework for their usage.…”

Antimicrobial activity of mesenchymal stem cells against Staphylococcus aureus

“…Bone penetration of many antibiotics has been studied [5][6][7][8][9][10], but the interpretation of results is difficult as the methodologies have not been standardized, and therefore, results have varied, but commonly used antibiotics such as vancomycin have poor bone penetration [2,7,11]. Recent attempts at local antibiotic delivery through an indwelling catheter in joint infections have only marginally improved outcomes [12][13][14]. Since these methods were introduced in the 1970s, there has been limited advancement in treatment.…”