Local Administration of Antibiotics in Orthopedics and Traumatology

Abstract

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.

Zusammenfassung

2022 jährte sich die Entwicklung der Antibiotikakette zum 50. Mal. Die Beladung von Knochenzementen mit Antibiotika war ein herausragender Fortschritt in der Behandlung muskuloskelettaler Infektionen; das Verfahren ist heute noch bewährter Standard. Die Erforschung wie auch Verwendung neuartiger Antibiotikaträger ist weiterhin ein wichtiger Bestandteil der Forschung im Kontext muskuloskelettaler Infektionen. Der Artikel gibt einen Überblick über die verschiedenen erhältlichen lokalen Antibiotika und deren Spezifika. Darüber hinaus werden aktuelle angepasste Behandlungskonzepte besprochen.

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

Schlüsselwörter

Antibiotikaträger - PMMA - Antibiotikakette - muskuloskelettale Infektion - periprothetische Infektion - implantatassoziierte Infektion - lokale Antibiotikatherapie - Cerament

^* This article is a republished version of: Gramlich Y, Schnetz M, Hoffmann R. Local Administration of Antibiotics in Orthopedics and Traumatology. Z Orthop Unfall 2023;161(5):563–583.

Publication History

Article published online:
09 January 2025

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