Antimicrobial biomaterials in the prevention and local treatment of infection in orthopedics

According to current views, infection around the orthopedic implant and in chronic osteomyelitis is associated with the development of a bacterial biofilm, which is a barrier to systemic administered antibiotics. This results in the inability to cure the infection with systemic antimicrobial therapy because the doses guaranteeing activity in the biofilm will be toxic to the patient. The antibiotic concentration effective against bacteria in the biofilm can be achieved by local administration. The main advantage of local antibiotic carriers is the local release of drugs in high concentrations that exceed those achievable after systemic administration, but without systemic toxicity. The vehicle should provide a high local concentration of antibiotic above the minimal inhibitory con- centrations (MIC) for the most common pathogens an should be effective against sedentary forms of bacteria. It can not impair the regeneration of bone tissue and the biological integration of the implant with the bone. Carriers that are both a substitute for bone and have osteoconductive or osteoinductive properties protect the bone from re-infection and promote the reconstruction of cavernous defects. Local carriers of antibacterial drugs may be absorbable or non-absorbable and depending on physico-chemical properties include 6 classes of biomaterials. Local carriers of antibacterial substances are currently being and will probably remain the treatment of choice of infections of orthopedic implants and osteomyelitis.