LOCAL ANTIBACTERIAL THERAPY FOR THE MANAGEMENT OF ORTHOPEDIC INFECTIONS - PHARMACOKINETIC CONSIDERATIONS

Bone infection has long been a formidable foe of orthopaedic surgeons. The standard method of treating osteomyelitis generally consists of i rrigation and debridement supplemented by pre- and postoperative antib iotics and intraoperative antimicrobial solutions. in the 1970s, Buchh olz introduced the concept of local antibacterial therapy in the form of antibiotic impregnated bone cement to treated infected arthroplasti es, From this, antibiotic impregnated beads were developed to treat lo cal infections of bone and soft tissue, The advantage of these beads c ompared with parenteral therapy is that they deliver a high concentrat ion of antibacterial locally while avoiding hi,oh systemic concentrati ons, thus avoiding adverse effects that are often associated with pare nteral antibacterial therapy. Additionally, methylmethacrylate bone ce ment does not significantly affect the immune response of the body. Th is makes the use of antibiotic-impregnated polymethylmethacrylate (PMM A) beads highly effective either as an alternative to, or in conjuncti on with, systemic antibiotic treatment of infected arthroplasties, and localised bone and soft tissue infection. This article explores the i ndications for the use of local therapy as well as any advantages or d isadvantages it may have over systemic antibacterial treatment. Additi onally, there are important pharmacokinetic considerations for the opt imal use of antibacterial agents in the treatment of osteomyelitis.