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Anwendung von Antibiotika im Knochen

Prophylaxe und aktuelle Therapiestandards

Use of antibiotics in bones

Prophylaxis and current treatment standards

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Zusammenfassung

Hintergrund

Die Behandlung von Infektionen des Knochens ist dadurch erschwert, dass durch die systemische Gabe von Antibiotika nur geringe Konzentrationen im entzündeten Knochengewebe erreicht werden und sowohl bei der Osteomyelitis wie bei implantatassoziierter Infektion Defekte häufig sind. Die lokale Anwendung von Antibiotika ist bei Knocheninfektionen auf vielfältige Weise zur Therapie und Prophylaxe durchgeführt worden. Ziel der Arbeit ist die Darstellung der Möglichkeiten und Grenzen des klinischen Einsatzes von antibiotikabeladen Knochentransplantaten.

Eignung

Knochentransplantate sind für Antibiotika als Wirkstoffträger geeignet, wobei die Beladung mit einer Vielfalt von Antibiotika individuell möglich ist. Kritische systemische Nebenwirkungen sind trotzt hoher Antibiotikakonzentrationen vor Ort unwahrscheinlich, wenn Beladungsobergrenzen eingehalten werden. Damit sind antibiotikabeladene Transplantate für die Prophylaxe in der Therapie geeignet. Bei Beladung im OP müssen die Bestimmungen des Arzneirechts berücksichtigt werden.

Verfahrensregeln

Da einheitliche Verfahrensregeln für die Beladung, Anwendung und Durchführung der Transplantation von antibiotikabeladenen Knochentransplantaten fehlen, sind die Fachgesellschaften gefordert, über ein Konsensusverfahren Empfehlungen bzw. Leitlinien zu erstellen, um den Anwendern Rechtsicherheit zu geben.

Abstract

Background

Treatment of bone infection is difficult due the systemic administration of antibiotics, which means that only low concentrations reach the inflamed bone tissue. Loss of bone stock is common in osteomyelitis and device associated infection. Local antibiotics are administered in several ways for prophylactic purposes and also for treatment of bone infection. We intend to show the options and limitations of clinical use of antibiotic-loaded bone grafts.

Suitability

Bone grafts are a suitable carrier system for antibiotics. Bone grafts may be loaded with a variety of antimicrobial agents so that individual therapies may be carried out. Critical systemic side effects are unlikely even though extreme high drug concentrations are obtained locally, if the thresholds for loading with antibiotics are respected. Thus, antibiotic-loaded bone grafts are appropriate for prophylaxis and therapy as well. If processing is done in the operating theatre compliance to the legal rules must be respected.

Rules

Due to a lack of standardised procedures for loading, application and performance of the application of antibiotic-loaded bone grafts medical societies are being asked to initiate consensus meetings in order to issue recommendations or guidelines with respect to antibiotic-loaded bone grafts to establish reliable rules for surgeons using these devices.

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Abbreviations

AMG:

Arzneimittelgesetz

MHK:

minimale Hemmkonzentration

PMMA:

Polymethylmethacrylat

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Authors and Affiliations

  1. Institut für Klinische Mikrobiologie, Infektiologie und Krankenhaushygiene, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland

    L. Frommelt

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  1. L. Frommelt
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Correspondence to L. Frommelt.

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L. Frommelt gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Frommelt, L. Anwendung von Antibiotika im Knochen. Orthopäde 47, 24–29 (2018). https://doi.org/10.1007/s00132-017-3508-1

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