已经提出关节内抗生素作为化脓性关节炎的治疗以允许高局部浓度而不使患者经受全身治疗的毒性/副作用。然而,关节内使用高浓度的这些溶液会引起软骨毒性的担忧。本系统评价的目的是评估抗生素和抗菌溶液的关节内使用,并在体外或体内给药后确定它们与软骨溶解的关联。
■根据PRISMA指南通过PubMed进行了系统评价,临床关键,OVID,谷歌学者。如果评估暴露于抗生素后的软骨毒性,则包括英语研究。
■最初的搜索导致了228项研究,36项研究符合标准。这36项研究包括研究24种不同药物的手稿。总的来说,24种药物中有7种(29%)是非软骨毒性的:米诺环素,四环素,氯霉素,替考拉宁,培氟沙星,利奈唑胺,多粘菌素杆菌肽.八种(33%)药物的结果不一致:多西环素,头孢曲松,庆大霉素,万古霉素,环丙沙星,氧氟沙星,氯己定,还有聚维酮碘.9种(38%)药物的软骨毒性明显,根据报告的估计的半数最大抑制浓度,所有这些都是剂量依赖性软骨毒性的(est.IC50):阿米卡星(est.IC50=0.31-2.74mg/mL),新霉素(0.82),头孢唑啉(1.67-3.95),头孢他啶(3.16-3.59),氨苄西林-舒巴坦(8.64->25),青霉素(11.61),阿莫西林(14.01),亚胺培南(>25),和妥布霉素(>25)。此外,多西环素和米诺环素的软骨保护作用被报道。
■本系统评价确定了可用于治疗化脓性关节炎的药物。由于其剂量依赖性软骨毒性作用,应避免使用九种药物。需要进一步的研究来阐明这些药物用于人类关节内使用的安全性。
UNASSIGNED: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for
chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration.
UNASSIGNED: A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for
chondrotoxicity following antibiotic exposure.
UNASSIGNED: The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine.
Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported.
UNASSIGNED: This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use.