Correspondence (reply): In Reply

Thaller missed a more comprehensive discussion of local antibiotic treatment in our article and comments that we cited only one study on the subject ([e33] in the article). Many aspects cannot be given enough space in the restricted context of a review article. These include the topic “local antibiotic therapy”; numerous publications have appeared on this subject, which have confirmed positive experiences with this approach. However, to date the scientific proof is missing that patients actually benefit from local antibiotic treatment. As early as in 1977, Klemm, who was one of the pioneers of introducing local antibiotic treatment, assessed its potential with some degree of criticism: “When discussing the frequency of recurrence after gentamycin-PMMA chains it needs to be stated first of all that even this new therapeutic approach cannot change the course of chronic osteomyelitis” (1).

When considering the shallow level to which gentamicin penetrates into the bone, which was shown by Wahlig in an animal model, it seems likely that local antibiotic carriers will be used primarily for the purposes of dead space management (2). Prophylactic coating of implants in order to prevent colonization and biofilm development, however, is a different matter. Their development is in its early stages and looks promising; we use these products too. They do not have a therapeutic purpose and their benefit has not been confirmed to date. In our article we mentioned these in the section on prevention.

Thaller’s criticism is justified in as far as we have not cited sufficient numbers of studies assessing local antibiotic therapy. Almost all studies of the treatment of chronic osteomyelitis do, however, include local antibiotic carriers; we merely omitted mentioning these again in that particular context (for example, references [7, 24, 25] in our article).