Table 3a.

Ceramics for Local Antibiotic Delivery

Reference	Material	Antibiotic	Tx Time	Controls	Sample Size	Cultures	Primary Findings
(Inzana et al., 2015b)	3D printed calcium phosphate scaffold	Vancomycin or Vancomycin + Rifampin	3 wk	+/− Systemic vanco, PMMA, PBO	7–15	Ground bone, soft tissue, implants	Rifampin + vancomycin from scaffolds significantly reduced CFU counts and volumetric osteolysis compared to vancomycin from PMMA. Only groups with rifampin achieved culture (−) bones
(Kundu et al., 2011)	Bioactive glass	Ceftriaxone + Sulbactam	6 wk	Systemic ceftriaxone + sulbactam, Untreated	3	None	Histopathologic scores significantly improved with bioactive glass vs. systemic at 12 and 21 days but not at 42 days; radiographic scores were better through 42 days with bioactive glass
(Amador et al., 2010)	Calcium-deficient apatite (CDA)	Vancomycin	7 d	Systemic vanco, CDA +/− sys. vanco, PBO	5–11	Joint fluid, marrow, & bone	Systemic vanco tended to reduce CFU and mortality rates; CDA significantly reduced CFU and mortality vs. PBO; Systemic vanco tended to additively augment effect of local vanco
(Faber et al., 2005)	Calcium phosphate paste	Gentamicin or Human Lactoferrin 1–11	3 wk	PBO, Untreaed	5–8	Swabs of biopsies	CFU counts were significantly reduced and histological scores significantly improved by gent and hLF1-11 vs. PBO
(Solberg et al., 1999)	HA paste	Gentamicin	7 wk	Systemic gentamicin, PMMA, Untreated	4	Ground bone	HA and PMMA steadily decreased CFU counts over time course to 100% culture (−) by 7 wks; HA was ~1 log CFU lower than PMMA at 3 wks. Systemic gent was not different from untreated
(Shirtliff et al., 2002)	HA paste	Vancomycin	4 wk	Systemic vanco, PMMA, PBO +/− systemic vanco, Untreated	8–12	Ground bone	Rates of culture (−) bones were significantly reduced by PMMA and HA with vanco. PMMA and HA were comparable. Systemic vanco did not have a significant effect.
(Joosten et al., 2004)	HA paste	Gentamicin	3 wk	Systemic gentamicin, PBO, Untreated	6	Biopsy and aspirate	100% culture (−) with HA vs. 0% with systemic gent; Histological scores significantly reduced vs. Untreated with HA, but not systemic gent
(Joosten et al., 2005)	HA paste	Vancomycin	3 wk	PBO	7–8	Biopsy	100% culture (−) with Tx vs. 0% with PBO; WBC counts and histo scores significantly reduced by Tx vs. PBO;
(Zelken et al., 2007)	HA paste	Vancomycin	3 wk	PMMA, Untreated	16	Ground bone	CFU counts significantly reduced with PMMA vs. HA paste and untreated
(Cornell et al., 1993)	HA beads	Gentamicin	40 d, 120 d	PBO, untreated	8–13	Biopsy and swabs	At 40 days, 73% culture (−) with HA vs. 0% of PBO and untreated; In the 120 d subset, 66% with HA Tx completely healed the osseous defect, controls were not considered for 120 d.
(Jiang et al., 2012)	Nano-HA pellets	Vancomycin	12 wk	PBO, Untreated	4	Biopsy	100% culture (−) with HA vs. 0% in PBO and untreated. Histo scores significantly improved with HA vs. PBO or untreated.

PBO – Placebo (material without antibiotics); (−) – negative; Tx – treatment; HA – hydroxyapatite; WBC – white blood cell