Review-Antibiotic Beads

Mrs. Anitha Victoria Noronha¹, Mrs. Purohith Saraswathi²

¹Assistant Professor, JSS College of Nursing, Mysuru

²Assistant Lecturer, JSS College of Nursing, Mysuru

*Corresponding Author’s Email: avinanithatony@gmail.com

ABSTRACT:

The appropriate use of antimicrobial agents has decreased morbidity and mortality from orthopedic-related infections. Although systemic antibiotic use has been used for many years, new methods of local antibiotic delivery may result in increased antibiotic levels, decreased toxicity, and possibly greater efficacy. Antibiotic-loaded beads are bactericidal, have a dose- dependent killing curve, remain stable when exposed to heat and are soluble in water. Antibiotic beads are available in the form of biodegradable and nonbiodegradable which has its own advantages and disadvantages.

KEYWORDS: Antibiotic beads, Infection, Biodegradable, Non biodegradable.

INTRODUCTION:

Bone and soft tissue infections are serious problems in orthopedic and reconstructive surgery. Especially, chronic osteomyelitis is a difficult infection to treat and eradicate. Long term parenteral antibiotics with multiple surgical debridements are often required for effective therapy¹. Therefore, it is understandable that continuous efforts are being made in the treatment of bone and soft tissue infections. There is a long history of local antibiotic use for the treatment of bone and soft tissue infections.

Fig 1. Antibiotic-loaded beads implanted adjacent to an infected segment.

HISTORY:

During World War I, Alexander Fleming observed that locally applied antiseptics failed to sterilize chronically infected wounds, but they did reduce the burden of bacteria. In 1939, the instillation of sulfanilamide crystals, along with thorough debridement, hemostasis, primary closure and immobilization, resulted in a reduced infection rate for open fractures¹. In the 1960s Sir John Charnley began using bone cement on numerous patients for the fixation of both the femur and acetabulum. Before the end of the decade, Buchholz came up with the idea of adding an antibiotic to the cement to decrease the incidence of infection².

Antibiotic beads have gained wide acceptance in orthopedics in the treatment of a variety of skeletal infections due to their ability to provide high concentrations of antibiotic at the site of infection^.Traditionally, beads have been made by hand in the operating room on the back table during the case. This is a time consuming and cumbersome process, and is an inefficient use of resources. The antibiotic is not uniformly distributed, the bead size and shape is inconsistent and the beads are not well attached to the wire. Currently beads are commercially available. Gentamicin-impregnated beads were created by Klemm in 1979 and were used to occupy dead space after debridement of infected bone related to chronic osteomyelitis⁴.

NEED FOR ANTIBIOTICS BEADS

1. Infections occur because of the high affinity of many germs to the surface of implants. Once settled, germs are less sensitive to antibiotics, as they are covered with a “slime” preventing them from attacks from the host defense mechanism. This renders treatment with systemic antibiotics.

2. The use of antibiotic-loaded bone cements allows for high local concentrations of antibiotics to be administered to the areas surrounding the implant, protecting the implant from the settling of germs.

3. Antibiotic-loaded bone cement antibiotics are bactericidal, have a dose- dependent killing curve, remain stable when exposed to heat and are soluble in water.

TYPES

1. Non-Biodegradable systems

Antibiotic-impregnated polymethylmethacrylate (PMMA) beads and self-setting bone cement have been used to treat chronic osteomyelitis allowing the local delivery of high concentrations of antibiotics, while avoiding potential systemic side effects

2. Biodegradable systems

In order to address some of the drawbacks of local delivery with PMMA, the use of local antibiotics from a biodegradable implant for osteomyelitis is an attractive alternative and has been actively investigated in recent years⁴.

CONCLUSION:

The appropriate use of antimicrobial agents has decreased morbidity and mortality from orthopedic-related infections. Although systemic antibiotic use has been used for many years, new methods of local antibiotic delivery may result in increased antibiotic levels, decreased toxicity, and possibly greater efficacy. There is considerable interest in finding methods of delivering effective doses of antimicrobial drugs locally, not only in orthopedics, but across a range of specialists. It is hoped that in the future, development of new implantable systems would be helpful to reduce the cost of drug therapy, increase the efficacy of drugs, and could enhance the patient’s compliance.

REFERENCES:

1. http://cdn.intechopen.com/pdfs/26559/InTechLocal_antibiotic_therapy_in_the_treatment_of_bone_and_soft_tissue_infections.pdf .Cited on 8.12.2015

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888784/. Cited on 8.3.2016

3. Local Antibiotic Therapy in Osteomyelitis Jaspaul S. Gogia, John P. Meehan, Paul E. Di Cesare, and Amir A. Jamali, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884906/ Cited on 23.01.2016

4. Diana Gomes Margarida Pereira. Ana Francisca Bettencourt. Osteomyelitis: an overview of antimicrobial therapy http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1984-82502013000100003 Cited on 8.3.2016

Received on 09.03.2016 Modified on 25.04.2016

Int. J. Adv. Nur. Management. 2016; 4(2): 164-166.

DOI: 10.5958/2454-2652.2016.00037.8