Local Administration of Antibiotics in Orthopedics and Traumatology

2022 marks the 50th anniversary of the development of the antibiotic loaded PMMA chain. The loading of bone cements with antibiotics was a major advance in the treatment of musculoskeletal infections and is still a proven standard today. The research and use of novel antibiotic carriers continues to be an important part of research in the context of musculoskeletal infections. The article provides an overview of the various local antibiotics available and their specifics. In addition, current adapted treatment concepts are discussed.

Kernaussagen

• Lokale Antibiotika gewinnen in den Therapiestrategien von Infektionen des Bewegungsapparates zunehmend an Bedeutung.

• Lokal applizierbare Antibiotikaträger ersetzen jedoch nicht das ausgiebige Débridement mit Entfernung von nekrotischem und infiziertem Gewebe sowie die Spülung in Kombination mit einer systemischen, teils biofilmwirksamen Antibiotikatherapie.

• Mit antibiotischen Trägersubstanzen, die sich nach PMMA etabliert haben, z. B. Träger auf Kalziumbasis und Knochenersatzstoffe, kann nun auf die Entfernung der Substanzen verzichtet werden, und es sind einzeitige Therapiekonzepte möglich.

• Der Einsatz lokaler Antibiotika und Antibiotikaträger erfordert umfangreiche Kenntnisse über Trägersubstanzen, deren Eigenschaften hinsichtlich Biokompatibilität und Abbaubarkeit sowie Elutionseigenschaften der eingesetzten Antibiotika und schließlich die Kenntnis der rechtlichen Rahmenbedingungen.

• Der Artikel gibt einen Überblick über die verschiedenen lokal verfügbaren Antibiotika und deren Besonderheiten. Darüber hinaus werden aktuelle angepasste Behandlungskonzepte diskutiert.

Highlights

• Local antibiotics are becoming increasingly important in the therapeutic strategies for musculoskeletal infections.

• Antibiotic carriers that can be applied locally cannot replace the basics of evidence-based treatment: extensive debridement with the removal of necrotic and infected tissue, implant management, and irrigation in combination with systemic, partly biofilm-effective, antibiotic therapy.

• Once other antibiotic carrier substances, e.g., calcium-based carriers and bone substitutes, came into more general use after PMMA, the removal of these carrier substances was no longer necessary and single-stage therapy concepts became possible.

• The use of local antibiotics and antibiotic carriers requires extensive knowledge of carrier substances, their properties in terms of biocompatibility and degradability, as well as the elution characteristics of the antibiotics used and, finally, a knowledge of the legal framework.

• This article provides an overview of various topical antibiotics and their special features. In addition, current adapted treatment concepts are discussed.

Keywords

antibiotic carrier - PMMA - antibiotic beads - musculoskeletal infection - Periprosthetic joint Infection - PJI - fracture related infection - FRI - local antibiotics

Publication History

Article published online:
28 September 2023

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