Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt.
Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Drug Deliv. 2021 Dec;28(1):2392-2414. doi: 10.1080/10717544.2021.1998246.
Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients' compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTSChronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options.Local drug delivery systems are receiving great attention in the recent decades.Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiationLocal systems can be designed to provide mechanical support for the long bones during the healing process.Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients' compliance.
慢性骨髓炎是一种具有挑战性的疾病，其死亡率和发病率都很高，而目前可用的治疗策略并不理想。与慢性骨髓炎手术后清创所采用的系统性治疗方法不同，局部药物输送系统在近几十年来受到了广泛关注。局部药物输送系统使用特殊载体具有增强抗菌药物渗透到骨组织的可行性、在感染区域提供抗菌药物的持续释放和局部浓度、同时避免全身副作用和毒性的优点。最重要的是，在这些系统中加入成骨诱导和骨传导材料有助于骨的增殖和分化，从而增强新骨材料的生成。这些系统中的一些还可以在愈合过程中为长骨提供机械支撑。最重要的是，如果局部系统设计为可注射到受影响部位且可生物降解，它们将减少植入所需的侵入性，并赢得患者的依从性，缩短愈合期。它们还可以在治疗过程中进行多次注射，以防止长期全身治疗的副作用。目前的综述介绍了不同的可用于治疗骨髓炎的抗菌药物输送方法，重点介绍了抗生素局部输送研究的最新进展。
亮点：慢性骨髓炎是一种具有挑战性的疾病，其死亡率和发病率都很高，且有效治疗选择有限。
近几十年来，局部药物输送系统受到了广泛关注。
局部系统中的成骨诱导和骨传导材料有助于骨的增殖和分化。
局部系统可以设计为在愈合过程中为长骨提供机械支撑。
将局部系统设计为可注射到受影响部位且可生物降解，可减少侵入性并赢得患者的依从性。
