Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review

Area of Science:

• Orthopedics
• Infectious Diseases
• Pharmacology

Background:

• Diabetic foot osteomyelitis (DFO) presents a significant clinical challenge.
• Local antibiotic delivery is explored as an adjunctive therapy post-surgery for DFO.
• Evidence on the efficacy of these local delivery systems requires comprehensive review.

Purpose of the Study:

• To systematically review existing evidence on local antibiotic delivery systems for DFO.
• To evaluate the effectiveness of various local antibiotic delivery methods in DFO treatment.
• To identify gaps in current research regarding local antibiotic delivery in DFO.

Main Methods:

• A comprehensive literature search was conducted in the PubMed database up to March 2020.
• Included studies comprised 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series.
• Data synthesis focused on clinical healing rates, hospitalization duration, amputation rates, and infection eradication.

Main Results:

• Gentamicin-impregnated collagen sponges in RCTs demonstrated significant improvements in clinical healing and hospitalization duration.
• Antibiotic-impregnated calcium sulfate beads in RSs showed non-significant improvements in healing parameters without reducing amputation rates.
• Case series, predominantly using calcium sulfate beads, reported adequate healing and infection eradication rates.

Conclusions:

• Current evidence supporting local antibiotic delivery as an adjunct to DFO surgery remains limited.
• Further high-quality research, including more RCTs, is necessary to definitively assess the benefits.
• Local antibiotic delivery systems show potential but require more robust data for widespread clinical recommendation in DFO.