Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients' compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTSChronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options.Local drug delivery systems are receiving great attention in the recent decades.Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiationLocal systems can be designed to provide mechanical support for the long bones during the healing process.Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients' compliance.
Keywords: 3 D printing; Osteomyelitis; bone grafts; bone scaffolds; local drug delivery; nanoparticles; tissue engineering.