感染性伤口的治疗:通过先进的药物输送系统克服临床挑战。

Therapy of infected wounds: overcoming clinical challenges by advanced drug delivery systems.

机构信息

Institute of Pharmaceutical Technology and Buchmann Institute for Molecular Life Sciences, Goethe University Frankfurt, Max-von-Laue-Str. 15, 60438, Frankfurt am Main, Germany.

出版信息

Drug Deliv Transl Res. 2021 Aug;11(4):1545-1567. doi: 10.1007/s13346-021-00932-7. Epub 2021 Feb 20.

Abstract

In recent years, the incidence of infected wounds is steadily increasing, and so is the clinical as well as economic interest in effective therapies. These combine reduction of pathogen load in the wound with general wound management to facilitate the healing process. The success of current therapies is challenged by harsh conditions in the wound microenvironment, chronicity, and biofilm formation, thus impeding adequate concentrations of active antimicrobials at the site of infection. Inadequate dosing accuracy of systemically and topically applied antibiotics is prone to promote development of antibiotic resistance, while in the case of antiseptics, cytotoxicity is a major problem. Advanced drug delivery systems have the potential to enable the tailor-made application of antimicrobials to the side of action, resulting in an effective treatment with negligible side effects. This review provides a comprehensive overview of the current state of treatment options for the therapy of infected wounds. In this context, a special focus is set on delivery systems for antimicrobials ranging from semi-solid and liquid formulations over wound dressings to more advanced carriers such as nano-sized particulate systems, vesicular systems, electrospun fibers, and microneedles, which are discussed regarding their potential for effective therapy of wound infections. Further, established and novel models and analytical techniques for preclinical testing are introduced and a future perspective is provided.

摘要

近年来,感染性伤口的发病率稳步上升,人们对有效治疗方法的临床和经济兴趣也日益浓厚。这些方法将减少伤口中的病原体负荷与一般伤口管理相结合,以促进愈合过程。当前疗法的成功受到伤口微环境恶劣条件、慢性和生物膜形成的挑战,从而阻碍了有效浓度的活性抗菌药物到达感染部位。全身性和局部应用抗生素的剂量准确性不足容易导致抗生素耐药性的发展,而对于防腐剂而言,细胞毒性是一个主要问题。先进的药物输送系统有可能实现针对作用部位的定制应用抗菌药物,从而进行有效治疗,而副作用可忽略不计。本文全面概述了治疗感染性伤口的现有治疗方法。在这方面,特别关注了从半固体和液体制剂到伤口敷料等更先进载体的抗菌药物输送系统,讨论了它们在有效治疗伤口感染方面的潜力。此外,还介绍了用于临床前测试的既定和新型模型和分析技术,并提供了未来展望。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74b8/8236057/a2294c2054fa/13346_2021_932_Fig1_HTML.jpg

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