Local antibiotic delivery vehicles in the treatment of musculoskeletal infection.

The primary benefit achieved with local antibiotic delivery vehicles is the ability to obtain extremely high levels of local antibiotics without increasing systemic toxicity. Antibiotic-loaded bone cement represents the current standard as an antibiotic delivery vehicle in orthopaedic surgery. Biodegradable alternatives to antibiotic-loaded bone cement also are being used clinically and there are many new products in the active stages of development. These alternatives can be categorized as bone graft, bone graft substitutes or extenders, natural polymers (protein-based products), and synthetic polymers. Composite biomaterials that simultaneously provide the functions of variable antibiotic delivery patterns and also contribute to the process of bone regeneration represent the most ideal class of local antibiotic delivery vehicles. High concentrations of certain antibiotics have been shown to affect the process of normal bone regeneration adversely in a dose dependent response. Considerable investigation still is required to determine the proper use of locally administered antibiotics to negotiate the balance between eradicating infection without excessively inhibiting the processes of bone regeneration.