Local delivery of antimicrobials in the treatment of bone infections

Abstract

Treatment of chronic osteomyelitis and infected non-unions revolves around four core principles: adequate debridement of infected bone and soft tissue, appropriate sampling for infection and targeted antibiotics, bony stabilization and soft-tissue coverage. Despite a specialist multidisciplinary approach to diagnosis and treatment, the management of chronic infection remains challenging. One of the central tenets of the surgical treatment of osteomyelitis is to ensure that the dead space left at the end of the surgery is appropriately managed. Whilst the key factor is undoubtedly the filling of the defect with healthy vascularized tissue, an attractive option to augment dead space management and maximize local antibiotic delivery is to use an antibiotic carrier that can fill the void and deliver high concentrations of local antibiotics. In this article, we will discuss the importance of local delivery of antibiotics as part of the debridement and dead space management, and we will describe the Oxford protocol.