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Review
. 2021 Nov 1;17(2):75-81.
doi: 10.1900/RDS.2021.17.75.

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

Christos Chatzipapas  1 , Makrina Karaglani  1 , Nikolaos Papanas  2 , Konstantinos Tilkeridis  1 , Georgios I Drosos  1
Affiliations
Review

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

Christos Chatzipapas et al. Rev Diabet Stud. .

Abstract

Diabetic foot osteomyelitis (DFO) is a severe, difficult to treat infection. Local antibiotic delivery has been studied as a potential therapeutic adjunct following surgery for DFO. This review aims to summarize the evidence on local antibiotic delivery systems in DFO. PubMed database was searched up to March 2020. Overall, 16 studies were identified and included: 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series. In the RCTs, gentamicin-impregnated collagen sponges significantly improved clinical healing rates and slightly improved duration of hospitalization. In the RSs, antibiotic-impregnated calcium sulfate beads non-significantly improved all healing parameters, but did not reduce post-operative amputation rates or time of healing. The majority of case series used calcium sulfate beads, achieving adequate rates of healing and eradication of infection. In conclusion, evidence for add-on local antibiotic delivery in DFO is still limited; more data are needed to assess this therapeutic measure.

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Conflict of interest statement

N. Papanas has been an advisory board member of Astra-Zeneca, Boehringer Ingelheim, MSD, Novo Nordisk, Pfizer, Takeda, and TrigoCare International. He has participated in sponsored studies by Astra-Zeneca, Eli-Lilly, GSK, MSD, Novo Nordisk, Novartis, and Sanofi-Aventis and has received honoraria as a speaker for Astra-Zeneca, Boehringer Ingelheim, Eli-Lilly, ELPEN, Galenica, MSD, Mylan, Novo Nordisk, Pfizer, Sanofi-Aventis, Takeda, and Vianex. He also attended conferences sponsored by TrigoCare International, Eli-Lilly, Galenica, Novo Nordisk, Pfizer, and Sanofi-Aventis.

References

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    1. Demetriou M, Papanas N, Panopoulou M, Papatheodorou K, Bounovas A, Maltezos E. Tissue and swab culture in diabetic foot infections: neuropathic versus neuroischemic ulcers. Int J Low Extrem Wounds 2013. 12:87-93. - PubMed
    1. Panagopoulos P, Drosos G, Maltezos E, Papanas N. Local antibiotic delivery systems in diabetic foot osteomyelitis: time for one step beyond? Int J Low Extrem Wounds 2015. 14:87-91. - PubMed
    1. Papanas N, Mani, R. Advances in infections and wound healing for the diabetic foot: the die is cast. Int J Low Extrem Wounds 2013. 12:83-86. - PubMed
    1. Georgakarakos E, Charalampidis D, Kakagia D, Georgiadis GS, Lazarides MK, Papanas N. Current achievements with topical negative pressure to improve wound healing in dehiscent ischemic stumps of diabetic patients: a case series. Int J Low Extrem Wounds 2013. 12:138-145. - PubMed

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