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osteomyelitis; delivery

J W Hudson, Austin P Daly, Michael Foster
PURPOSE: To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution...
March 18, 2017: Journal of Oral and Maxillofacial Surgery
Kenneth L Koury, John S Hwang, Michael Sirkin
Antibiotic cement nails provide a useful and relatively simple technique to treat intramedullary osteomyelitis of the long bones. These devices provide stability as well as local, targeted antibiotics, which are both critical aspects of osteomyelitis management. Additionally, the use of a threaded core is a critical component of successful cement nail assembly. With adherence to the simple principles outlined in this review, surgeons can expect reliably good results using these drug-delivery implants.
April 2017: Orthopedic Clinics of North America
Zhidong Cao, Dianming Jiang, Ling Yan, Jun Wu
Antibiotic-loaded carriers were developed to fill cavities and locally deliver antibiotics following implantation. However, the most commonly used antibiotic carrier, polymethyl methacrylate (PMMA), has many disadvantages including that it does not promote bone regeneration or conduction. Vancomycin-loaded bone-like hydroxyapatite/poly amino acid (V-BHA/PAA) was successfully fabricated by a homogeneous method, certified as biosafe and known to promote osteogenesis. To evaluate its drug-release features, the quantity of the vancomycin in the elution was obtained every 2 days after in vitro simulated body fluid immersion...
2017: International Journal of Nanomedicine
Yang Zhang, Ruo-Jia Liang, Jiao-Jiao Xu, Li-Feng Shen, Jian-Qing Gao, Xu-Ping Wang, Na-Ni Wang, Dan Shou, Ying Hu
Surgery and the local placement of an antibiotic are the predominant therapies to treat chronic osteomyelitis. Vancomycin-loaded N-trimethyl chitosan nanoparticles (VCM/TMC NPs) as a potential drug delivery system have high intracellular penetration and effective intracellular antibacterial activity. This study investigated the effects of a biocompatible material, poly(trimethylene carbonate) (PTMC), to increase the sustained effectiveness of an intracellular antibiotic and its potential application in antibiotic delivery...
2017: International Journal of Nanomedicine
Parish P Sedghizadeh, Shuting Sun, Adam F Junka, Eric Richard, Keivan Sadrerafi, Susan Mahabady, Neema Bakhshalian, Natalia Tjokro, Marzenna Bartoszewicz, Monika Oleksy, Patrycja Szymczyk, Mark W Lundy, Jeffrey D Neighbors, R Graham G Russell, Charles E McKenna, Frank H Ebetino
Osteomyelitis is a major problem worldwide and is devastating due to the potential for limb-threatening sequelae and mortality. Osteomyelitis pathogens are bone-attached biofilms, making antibiotic delivery challenging. Here we describe a novel osteoadsorptive bisphosphonate-ciprofloxacin conjugate (BV600022), utilizing a "target and release" chemical strategy, which demonstrated a significantly enhanced therapeutic index versus ciprofloxacin for the treatment of osteomyelitis in vivo. In vitro antimicrobial susceptibility testing of the conjugate against common osteomyelitis pathogens revealed an effective bactericidal profile and sustained release of the parent antibiotic over time...
February 13, 2017: Journal of Medicinal Chemistry
Negar Hassani Besheli, Fatemeh Mottaghitalab, Masoud Eslami, Mahdi Gholami, Subhas C Kundu, David L Kaplan, Mehdi Farokhi
The successful treatment of bone infections is a major challenge in the field of orthopedics. There are some common methods for treating bone infections, including systemic antibiotic administration, local nondegradable drug vehicles, and surgical debridement, and each of these approaches has advantages and disadvantages. In the present study, the antibiotic vancomycin (VANCO) was loaded in silk fibroin nanoparticles (SFNPs) and the complexes were then entrapped in silk scaffolds to form sustained drug delivery systems...
February 6, 2017: ACS Applied Materials & Interfaces
Ajay Bharti, Umesh Kumar Saroj, Vineet Kumar, Sanjay Kumar, Balram Ji Omar
The intramedullary insertion of antibiotic impregnated PMMA rods, beads or nails are widely used and accepted modality of treatment for chronic osteomyelitis of long bones. But at times it becomes difficult to insert and remove these antibiotic delivery systems owing to narrowed medullary canals. Here we present a technique for preparing PMMA rods with diameter ranging from 6 mm to 3 mm. These rods could easily be placed in narrow intramedullary canal of long bones with chronic osteomyelitis or infected non-union...
October 2016: Journal of Clinical Orthopaedics and Trauma
Zhang Wentao, Guangyu Lei, Yang Liu, Wei Wang, Tao Song, Jinzhu Fan
BACKGROUND: To reduce the incidence of osteomyelitis infection, local antibiotic impregnated delivery systems are commonly used as a promising and effective approach to deliver high antibiotic concentrations at the infection site. OBJECTIVE: The objective of this review was to provide a literature review regarding approach to osteomyelitis treatment with antibiotic loaded PMMA. STUDY DESIGN: Literature study regarding osteomyelitis treatment with antibiotic loaded carriers using key terms Antibiotic, osteomyelitis, biodegradable PMMA through published articles...
January 2017: Microbial Pathogenesis
Mitchell C Birt, David W Anderson, E Bruce Toby, Jinxi Wang
This review article summarizes the recent advances in pathogenic mechanisms and novel therapeutic strategies for osteomyelitis, covering both periprosthetic joint infections and fracture-associated bone infections. A better understanding of the pathophysiology including the mechanisms for biofilm formation has led to new therapeutic strategies for this devastating disease. Research on novel local delivery materials with appropriate mechanical properties, lower exothermicity, controlled release of antibiotics, and absorbable scaffolding for bone regeneration is progressing rapidly...
March 2017: Journal of Orthopaedics
Chien-Lin Pan, Ming-Hong Chen, Fu-I Tung, Tse-Ying Liu
Many non-antibiotic strategies, such as photocatalysis and photodynamic therapy, have been proposed to inhibit and/or kill bacteria. However, these approaches still have drawbacks such as insufficient bacterial specificity and the limited penetration depth of ultraviolet and near-infrared light. To overcome these limitations, we developed a bacteria-specific anti-bacterial technique via using low-dose X-ray. Graphene oxide quantum dots (GQDs, a multifunctional vehicle) conjugated with vancomycin (Van, a bacteria-targeting ligand) were assembled with Protoporphyrin IX (PpIX, a photo/radiation sensitizer) to yield a novel Van-GQDs/PpIX complex that specifically attached to Escherichia coli and efficiently generated intracellular reactive oxygen species following X-ray activation...
October 3, 2016: Acta Biomaterialia
Samit Kumar Nandi, Samiran Bandyopadhyay, Piyali Das, Indranil Samanta, Prasenjit Mukherjee, Subhasis Roy, Biswanath Kundu
Chronic osteomyelitis is a major challenge in bone surgery. Conventional use of antibiotics is not an effective way to control the malaise due to so many reasons. Determination of optimal treatment strategy becomes difficult for the orthopaedic surgeons and as a consequence, the patients suffer not only from therapeutic failure but also due to adverse side effects of antibiotics and financial loss due to additional stay at hospitals. A wide application of carrier systems, as a medium for local delivery of antibiotics, is being used experimentally and clinically for the treatment of osteomyelitis...
December 2016: Biotechnology Advances
M Stravinskas, P Horstmann, J Ferguson, W Hettwer, M Nilsson, S Tarasevicius, M M Petersen, M A McNally, L Lidgren
OBJECTIVES: Deep bone and joint infections (DBJI) are directly intertwined with health, demographic change towards an elderly population, and wellbeing.The elderly human population is more prone to acquire infections, and the consequences such as pain, reduced quality of life, morbidity, absence from work and premature retirement due to disability place significant burdens on already strained healthcare systems and societal budgets.DBJIs are less responsive to systemic antibiotics because of poor vascular perfusion in necrotic bone, large bone defects and persistent biofilm-based infection...
September 2016: Bone & Joint Research
Y Z Long, Z X Zhu, Y Yu, S M Zhang
Chronic osteomyelitis (COM) is an infectious disease caused by methicillin-resistant Staphylococcus aureus (MRSA), the main characteristics of COM including local dead bone formation, soft tissue infection, and repeatedly attacks. As a sensitive antibiotic, vancomycin plays an important role in the therapy of COM caused by MRSA. Currently, drug treatment is divided into systemic and topical, systemic medication is given priority to intravenous drug delivery; local drug application including local delivery device and local antibiotics lavage and regional arterial perfusion...
September 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Amany A Mostafa, Mayyada M H El-Sayed, Azza A Mahmoud, Amira M Gamal-Eldeen
Local delivery of antibiotic into injured bone is a demand. In this work, different scaffolds of chitosan (C) with or without bioactive glass (G) were prepared using the freeze-drying technique in 2:1, 1:1, and 1:2 weight ratios. Chitosan scaffolds and selected formulas of chitosan to bioglass were loaded with ciprofloxacin in 5%, 10%, and 20% w/w. Scaffold morphology showed an interconnected porous structure, where the glass particles were homogeneously dispersed in the chitosan matrix. The kinetic study confirmed that the scaffold containing 1:2 weight ratio of chitosan to glass (CG12) showed optimal bioactivity with good compromise between Ca and P uptake capacities and Si release rate...
August 12, 2016: AAPS PharmSciTech
Catherine Loc-Carrillo, Caroline Wang, Ahranee Canden, Michael Burr, Jayant Agarwal
Current treatments for methicillin-resistant Staphylococcus aureus (MRSA) infections require intravenously delivered vancomycin; however, systemically delivered vancomycin has its problems. To determine the feasibility and safety of locally delivering vancomycin hydrochloride (~25 mg/Kg) to the medullary canal of long bones, we conducted a pharmacokinetics study using a rat tibia model. We found that administering the vancomycin intraosseously resulted in very low concentrations of vancomycin in the blood plasma and the muscle surrounding the tibia, reducing the risk for systemic toxicity, which is often seen with traditional intravenous administration of vancomycin...
2016: PloS One
B Tuleubaev, D Saginova, T Abiyev, M Davletbaev, A Koshanova
Despite the variety of treatments available, including surgical procedures and antimicrobial therapy, bone infections is still a medical problem, because they are difficult to treat. Optimal treatment should stabilize the bone, promote the biological recovery of bone defects and destroy bacterial infection. Systemic antibiotics are part of the standard therapy after surgical treatment of infected bone, but their effectiveness is limited due to malnutrition and low absorption at the site of infection. Moreover, long-term treatment and higher doses are associated with serious side effects...
June 2016: Georgian Medical News
Vaya W Tanamai, Brandon-Luke L Seagle, Guoyang Luo
BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing, and 0.5-4% of pregnant women are colonized. CASE: A 30-year-old pregnant woman at term presented with intractable headache 1 week after incision and drainage of a MRSA-positive axillary abscess. Imaging demonstrated a right-sided epidural abscess with midline shift and myositis of the overlying temporalis muscle. She underwent cesarean delivery followed by craniectomy of osteomyelitic bone and evacuation of the epidural abscess...
May 2016: Journal of Reproductive Medicine
Vuk Uskoković, Victoria M Wu
Socially responsible technologies are designed while taking into consideration the socioeconomic, geopolitical and environmental limitations of regions in which they will be implemented. In the medical context, this involves making therapeutic platforms more accessible and affordable to patients in poor regions of the world wherein a given disease is endemic. This often necessitates going against the reigning trend of making therapeutic nanoparticles ever more structurally complex and expensive. However, studies aimed at simplifying materials and formulations while maintaining the functionality and therapeutic response of their more complex counterparts seldom provoke a significant interest in the scientific community...
June 2016: Materials
Andrew S Hendrix, Thomas J Spoonmore, Aimee D Wilde, Nicole E Putnam, Neal D Hammer, Daniel J Snyder, Scott A Guelcher, Eric P Skaar, James E Cassat
Staphylococcus aureus osteomyelitis is a common and debilitating invasive infection of bone. Treatment of osteomyelitis is confounded by widespread antimicrobial resistance and the propensity of bacteria to trigger pathological changes in bone remodeling that limit antimicrobial penetration to the infectious focus. Adjunctive therapies that limit pathogen-induced bone destruction could therefore limit morbidity and enhance traditional antimicrobial therapies. In this study, we evaluate the efficacy of the U...
September 2016: Antimicrobial Agents and Chemotherapy
Catarina F Marques, Ana C Matos, Isabel A C Ribeiro, Lídia M Gonçalves, Ana Bettencourt, José M F Ferreira
Several types of biodegradable materials have been investigated for the treatment of osteomyelitis. Calcium phosphate (CaP) ceramics are among the most performing materials due to their resemblance to human hard tissues in terms of mineralogical composition, and proven ability to adsorb and deliver a number of drugs. This research work was intended to study the suitability of modified CaP powders loaded with a fluoroquinolone as drug delivery systems for osteomyelitis treatment. Levofloxacin (LEV) was chosen due to the well-recognized anti-staphylococcal activity and adequate penetration into osteoarticular tissues...
July 2016: Journal of Materials Science. Materials in Medicine
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