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Advisor(s)
Abstract(s)
A osteomielite é uma infeção, geralmente bacteriana, do osso com uma inflamação simultânea dos tecidos adjacentes, conduzindo à destruição óssea. Muitos antibióticos são limitados por índices terapêuticos estreitos e toxicidade. Estas limitações podem ser ultrapassadas através da utilização de um sistema de administração, que modifica a distribuição do medicamento no organismo, direcionando-o para o local desejado e controlando a sua libertação. O objetivo geral desta dissertação é caracterizar os sistemas de veiculação de fármacos antimicrobianos para o osso e potencial aplicação no tratamento da osteomielite. A pergunta de investigação definida foi “os sistemas de veiculação local de fármacos melhoram os resultados do tratamento em doentes com osteomielite, em comparação com os tratamentos sem recurso a sistemas de libertação controlada?”. A metodologia escolhida foi a PRISMA. As fontes de informação selecionadas foram a Pubmed, Cochrane e Web of Science. As referências das bases de dados foram combinadas e processadas de acordo com os critérios de elegibilidade. Dos 78 estudos encontrados, 22 foram incluídos nesta revisão sistemática. Após a revisão dos estudos, parece que o Polimetilmetacrilato (PMMA) é uma boa escolha quanto à estabilidade mecânica e segurança. A escolha do sulfato de cálcio (SC) deve-se aparentemente às desvantagens do PMMA, e a adição de hidroxiapatite é aparentemente uma tentativa bem-sucedida de otimização do SC e colmatar as suas limitações. O principal objetivo da aplicação de um sistema de veiculação de fármacos parece ser minimizar a abordagem cirúrgica no controlo da doença, com um interesse crescente em desenvolver uma metodologia de um só ato cirúrgico. Apesar de muitas abordagens cirúrgicas estarem disponíveis, ainda não há consenso estabelecido sobre o tratamento ideal. As perspetivas futuras incluem sistemas locais de administração que satisfaçam as necessidades de diferentes doentes.
ABSTRACT - Osteomyelitis is an infection, usually bacteria, of bone a simultaneous inflammation involving the surrounding tissues which lead to bone destruction. Many antibiotics are limited by narrow therapeutic windows and toxicity. These handicaps can be circumvented through the use of an appropriately designed delivery system, which can modify the distribution of the drug in the body by targeting it to the desired site and by controlling its release. The main purpose of this dissertation is to characterize the different drug delivery systems used to administer antimicrobial drugs to treat osteomyelitis. A search question was conceived in the PICO (Patient/Population, Intervention, Comparison, and Outcomes) strategy, resulting in: Are drug delivery systems an advantageous approach for local treatment in osteomyelitis clinical studies, resulting in patients’ health improvement? The methodology chose the PRISMA statement. The information sources chosen were Pubmed, Cochrane, and Web of Science. References from the databases were combined and processed according to the eligibility criteria. Of the 77 studies screened, 22 were included in this systematic review. After reviewing the studies, it seems that the choice of polymethyl methacrylate (PMMA) is mainly based on it being the best option for mechanical stabilization and safety. The choice of calcium sulfate apparently is due to PMMA disadvantages, and the addition of hydroxyapatite is an attempt, successful in the studies reviewed, to improve the use of calcium sulfate and its limitations when used alone. The main purpose of using a delivery system seems to be to minimize the surgical approach in the management of the disease, with an increasing interest in developing a one-stage procedure. Even though many surgical approaches are available, there is still no established consensus on the ideal treatment. Future perspectives include local delivery systems that meet different patients’ needs.
ABSTRACT - Osteomyelitis is an infection, usually bacteria, of bone a simultaneous inflammation involving the surrounding tissues which lead to bone destruction. Many antibiotics are limited by narrow therapeutic windows and toxicity. These handicaps can be circumvented through the use of an appropriately designed delivery system, which can modify the distribution of the drug in the body by targeting it to the desired site and by controlling its release. The main purpose of this dissertation is to characterize the different drug delivery systems used to administer antimicrobial drugs to treat osteomyelitis. A search question was conceived in the PICO (Patient/Population, Intervention, Comparison, and Outcomes) strategy, resulting in: Are drug delivery systems an advantageous approach for local treatment in osteomyelitis clinical studies, resulting in patients’ health improvement? The methodology chose the PRISMA statement. The information sources chosen were Pubmed, Cochrane, and Web of Science. References from the databases were combined and processed according to the eligibility criteria. Of the 77 studies screened, 22 were included in this systematic review. After reviewing the studies, it seems that the choice of polymethyl methacrylate (PMMA) is mainly based on it being the best option for mechanical stabilization and safety. The choice of calcium sulfate apparently is due to PMMA disadvantages, and the addition of hydroxyapatite is an attempt, successful in the studies reviewed, to improve the use of calcium sulfate and its limitations when used alone. The main purpose of using a delivery system seems to be to minimize the surgical approach in the management of the disease, with an increasing interest in developing a one-stage procedure. Even though many surgical approaches are available, there is still no established consensus on the ideal treatment. Future perspectives include local delivery systems that meet different patients’ needs.
Description
Mestrado em Farmácia - Área de especialização: Farmacologia e Farmacoterapia Avançada
Keywords
Osteomielite Sistema de veiculação de fármacos Fármaco antimicrobiano Biomateriais Resultados clínicos Osteomyelitis Drug delivery system Anti-bacterial agents Biocompatible materials Treatment outcome
Citation
Corceiro AI. Sistemas de veiculação de fármacos antimicrobianos para tratamento da osteomielite: uma revisão sistemática [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2022.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa