Systematic Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and their Association with Chondrolysis

Category: Arthroscopy; Other Introduction/Purpose: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to systemic therapy and its associated toxicity/side effects. However, there is concern for chondrotoxicity with intra-articular use of antimicrobials and antiseptic solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, determine their association with chondrolysis following in vitro or in vivo administration, and identify the dosages at which they become chondrotoxic. Methods: A systematic review was conducted following the PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies were included if they were written in the English language and evaluated for chondrotoxicity following in vitro or in vivo intra-articular exposure to an antibiotic and antiseptic solutions. All agents, study characteristics, and conclusions were extracted and summarized. Results: The initial search resulted in 228 studies, with 36 meeting full inclusion criteria. Overall, chondrotoxicity was not associated with 7 out of 24 (29%) included agents: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Inconsistent results were noted with 8 (33%) agents: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependently chondrotoxic based on reported estimated half maximal inhibitory concentrations (est.IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82 mg/mL), cefazolin (1.67-3.95 mg/mL), ceftazidime (3.16-3.59 mg/mL), ampicillin- sulbactam (8.64 - >25 mg/mL), penicillin (11.61 mg/mL), amoxicillin (14.01 mg/mL), imipenem (>25 mg/mL), and tobramycin (>25 mg/mL). Additionally, certain studies reported chondroprotective effects of doxycycline and minocycline. Conclusion: This systematic review identified antimicrobial and antiseptic agents that may be used in the treatment of septic arthritis. The following agents should be avoided due to their dose-dependent chondrotoxic effects: amikacin, neomycin, cefazolin, ceftazidime, ampicillin-sulbactam, penicillin, amoxicillin, imipenem, and tobramycin. Further studies, especially in human models, are needed to clarify the safety of these medications for human intra-articular use

Neurocognition in PTSD: Treatment Insights and Implications.

Post-traumatic stress disorder (PTSD) is classified as a traumatic stress-related condition and is most often discussed in terms of emotional dysfunction. However, given that cognitive and emotional processes are intricately intertwined, implemented by overlapping brain networks, and effectively integrated in at least some of the same regions (e.g., prefrontal cortex, for a review, see Crocker et al. 2013), an abundance of literature now highlights the key role that cognitive functioning plays in both the development and maintenance (or exacerbation) of PTSD symptoms (Aupperle et al. 2012a; Verfaellie et al. 2012). Findings from this body of work detail objective impairment in neuropsychological function in those with PTSD (Brandes et al. 2002; Hayes et al. 2012a; Koenen et al. 2001). Yet despite the impact of neurocognition on PTSD treatment engagement and success (e.g., Haaland et al. 2016; Nijdam et al. 2015) and conversely, the role of PTSD treatment in normalizing cognitive dysfunction, a much smaller literature exists on neurocognitive changes following treatment for PTSD. Even aside from its role in treatment, cognitive functioning in PTSD has significant implications for daily functioning for individuals with this disorder, as cognition is predictive of school achievement, obtaining and maintaining employment, job advancement, maintaining relationships, greater wealth, and better health and quality of life (e.g., Diamond and Ling 2016)