Summary
In the face of increasing incidence of multidrug resistant implant infections, local
antibiotic modalities are receiving increased attention for both infection prophylaxis
and treatment. Local antibiotic therapy that achieves very high antibiotic drug concentrations
at the site of the implant may represent an avenue for treatment of biofilmforming
bacterial pathogens. Randomized controlled trials in human patients have demonstrated
an infection risk reduction when antibiotic-impregnated cement is used for infection
prophylaxis in implanted joint prostheses, and when a gentamicin-impregnated collagen
sponge is used for infection prophylaxis in midline sternotomy. The other modalities
discussed have for the most part yet to be evaluated in randomized controlled trials
in veterinary or human patients. In general, the in vivo pharmacokinetics and appropriate dosing profiles for local antibiotic modalities
have yet to be elucidated. Toxicity is possible, and attention to the dose applied
is warranted.
Keywords
Antibiotics - implant - infection - local antibiotic delivery