title: In vitro and in vivo effects of antibiotics on bone cell metabolism and fracture healing.
abstract: BACKGROUND
  Recent evidence suggests that antibiotics exert direct effects on bone at a cellular level, disrupting mitochondrial function and cell activity. This comprehensive literature review aims to evaluate evidence for the effects of antibiotics and antimicrobials on bone and discuss the clinical implications.
  
  
  METHODS
  A literature search was conducted on electronic databases covering a period from 1969 to 2010. Studies were included if they reported in vivo and in vitro experimental findings regarding the use of antibiotics and synthetic antibacterials in both animals and humans, focusing on bone cell function and especially fracture repair.
  
  
  CONCLUSIONS
  Current research suggests that these negative results could be due to direct effects of antibiotics on mitochondrial physiology within mammalian cells. Treatment doses of antibiotics, especially those released from topical delivery systems such as bone cements, result in antibiotic concentrations thousands of times higher than those required to inhibit bacterial growth. Our findings suggest a need to develop current antibiotic delivery systems to elute sufficient doses to inhibit bacterial growth without negative effects on bone physiology and fracture repair processes.
authors.affiliation: Leeds University, Leeds School of Medicine, Academic Orthopaedic Department, Leeds General Infirmary, Leeds, LS1 3EX, UK.
authors.forename: Rami
authors.initials: R
authors.lastname: Kallala
authors.forename: Simon Matthew
authors.initials: SM
authors.lastname: Graham
authors.forename: Dariush
authors.initials: D
authors.lastname: Nikkhah
authors.forename: Margaritis
authors.initials: M
authors.lastname: Kyrkos
authors.forename: Manolis
authors.initials: M
authors.lastname: Heliotis
authors.forename: Athanassios
authors.initials: A
authors.lastname: Mantalaris
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
mesh_terms: D000287:Administration, Topical; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects; D001842:Bone and Bones / Q000166:cytology / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D017102:Fracture Healing / Q000187:drug effects*; D006801:Humans; D008928:Mitochondria / Q000187:drug effects / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents