Abstract / Summary
Osteomyelitis remains one of the most challenging infections to manage in both human and veterinary orthopedics, owing to biofilm formation, compromised local vascularity, and the frequent need for extensive surgical debridement. Systemic antibiotic therapy alone often fails to achieve bactericidal concentrations at the infected site while exposing the patient to systemic toxicity. Local antibiotic delivery systems have therefore emerged as a complementary or alternative strategy, enabling sustained, high local drug concentrations above the minimum inhibitory concentration while minimizing systemic exposure. This review summarizes the principal approaches to managing osteomyelitis—surgical intervention, systemic antimicrobial therapy, and local drug delivery—with an emphasis on the biomaterials used as antibiotic carriers. Non-degradable and biodegradable systems are discussed, including poly(methyl methacrylate) cements, calcium sulfate, calcium phosphate ceramics, bioactive glasses, and natural and synthetic polymers, such as chitosan, poly(lactic acid), and poly(lactic-co-glycolic acid), as well as bone-graft-based carriers. Particular attention is given to injectable, in situ-forming scaffolds that combine antimicrobial release with osteoconductive and osteoinductive properties, offering dual eradication of pathogens and support for bone regeneration. Current limitations, the comparative relevance of the canine model, and future directions—including nano-bioactive glass composites and combination therapy—are considered to guide the development of more effective single-stage treatment strategies.