title: Systematic approach to treat chronic osteomyelitis through localized drug delivery system: bench to bed side.
abstract: Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone-sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8-18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50-55% porosity, average pore size 110 μm, higher interconnectivity (10-100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients.
authors.affiliation: Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004, India.
authors.forename: Rupnarayan
authors.initials: R
authors.lastname: Bhattacharya
authors.forename: Biswanath
authors.initials: B
authors.lastname: Kundu
authors.forename: Samit Kumar
authors.initials: SK
authors.lastname: Nandi
authors.forename: Debabrata
authors.initials: D
authors.lastname: Basu
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D002908:Chronic Disease; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D011817:Rabbits; D013210:Staphylococcus / Q000166:cytology; D013407:Sulbactam / Q000494:pharmacology / Q000627:therapeutic use; D013977:Tibia / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology / Q000648:ultrastructure; D014057:Tomography, X-Ray Computed; D057170:Translational Research, Biomedical; D055815:Young Adult
chemical_list: D002443:Ceftriaxone; D013407:Sulbactam
keywords: Antibiotic; Chronic osteomyelitis; Human application; In vivo animal trial; Porous hydroxyapatite