Efficacy and safety of antibiotic-loaded nanohydroxyapatite beads in the management of chronic osteomyelitis

The research investigated the effectiveness and security of antibiotic-impregnated nanohydroxyapatite beads (nHA-ATB) as a treatment for chronic osteomyelitis through a retrospective study. The study included 42 patients who received surgical debridement and nHA-ATB beads with gentamicin, vancomycin or fosfomycin for refractory chronic osteomyelitis. The assessment included demographics, Cierny-Mader classification, microbiological profiles, therapeutic drug monitoring, inflammatory markers, radiographic parameters, and quality of life (SF-36) over 48 weeks. The patient population consisted of 61.9% males with an average age of 48±14 years who mainly had lower extremity infections (76.2%). The success rate achieved 88.1% at the 48-week mark. The success of treatment depended on the extent of anatomic spread and host condition and particular comorbidities. Gentamicin and vancomycin produced better results than fosfomycin in treatment outcomes (p=0.042). The strong relationship between material resorption rates (90.5%) and bone healing outcomes (71.4%) was demonstrated through a correlation coefficient of r=0.85 (p<0.001). The inflammatory markers returned to normal in 83.3% of patients who also showed major improvements across all SF-36 domains. The high local antibiotic concentrations did not result in any systemic toxicity. The nHA-ATB beads demonstrated both safety and effectiveness in treating chronic osteomyelitis through their targeted antimicrobial action and bone regenerative properties. The dual delivery system of antibiotics with host bone integration provides better benefits than conventional antibiotic delivery methods. Further research should include multicenter randomized controlled trials with extended follow-up to determine the comparative efficacy of this treatment against standard intravenous antibiotic therapies for different patient groups.