Antibiotic-loaded bone cement shows promise for paediatric chronic osteomyelitis, achieving 100% infection-free outcomes

Treating paediatric chronic osteomyelitis presents significant challenges due to the complex nature of bone infections in growing children, often requiring prolonged and aggressive interventions. Traditional systemic antibiotic therapy can struggle to reach therapeutic concentrations at the infection site, leading to treatment failures and recurrence. Local antibiotic delivery systems, such as antibiotic-loaded bone cement, offer a promising strategy by providing high local drug concentrations directly where needed, minimizing systemic side effects and potentially improving eradication rates. This approach aims to bridge the gap in effective, localized treatment options for this vulnerable patient population.

This scoping review systematically mapped existing research on the use of antibiotic-loaded bone cement for paediatric chronic osteomyelitis. Conducted in July 2023, the review searched PubMed, Scopus, Cochrane, Google Scholar, and ScienceDirect databases for original research articles. Data extracted included basic bibliographic details, patient demographics, clinical presentation, identified pathogens, systemic and local antibiotic treatments, operative techniques, follow-up duration, outcomes, and reported complications.

Of the 1,569 studies initially identified, 158 (10.07%) were assessed for eligibility, ultimately leading to 9 (5.7%) studies being reviewed in detail. All 9 (100%) included studies were retrospective in design, with 6 (66.6%) classified as case series. The total patient cohort across these studies comprised 73 paediatric patients, of whom 58 (79.5%) were males. The tibia was the most commonly involved bone, accounting for 21 (46%) cases. Vancomycin was the most frequently incorporated antibiotic in the bone cement, used in 60 (83.6%) of the patients.

All 73 (100%) patients were reported as infection-free at the conclusion of their respective follow-up periods, with 55 (75.3%) patients experiencing no major complications.