Local antibiotic delivery systems for the treatment of osteomyelitis – A review

Osteomyelitis, an inflammatory process accompanied by bone destruction, is caused by infective microorganisms. The high success rates of antimicrobial therapy by conventional routes of administration in controlling most infectious diseases have not yet been achieved with osteomyelitis for several reasons. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes. This review introduces osteomyelitis – its present options for drug delivery and their limitations, and the wide range of carrier materials and effective drug choices. Local drug delivery for osteomyelitis is a topic of importance for more than 20 years. Carrier materials used for local delivery of antibiotics may be classified as nonbiodegradable and biodegradable. Commonly used non biodegradable carrier materials are polymethyl methacrylate (PMMA), Acrylic beads, PMMA bone cement etc. and biodegradable materials are hydroxyapatite block, bioactive glass ceramics, collagen sponge, polylactide/ployglycolide implants. Both the systems release antibiotic at concentrations exceeding the minimum inhibitory concentrations (MICs) for the most common pathogens involved in osteomyelitis without causing any adverse systemic effects although non biodegradable beads are to be removed from the surgical site after completion of antibiotic release.