The musculoskeletal system can present a variety of
challenges for antimicrobial therapy (Table 10.5). It
is difficult to reach therapeutic antimicrobial levels
in many tissues, such as bone, tendon, tendon sheath
and joints following oral or parenteral antimicrobial
administration. Alternative approaches such as intraarticular
therapy, intra-osseous infusion and regional
perfusion may be useful in many situations to provide
very high local antimicrobial levels. The tendency
for abscess formation in soft tissues presents further
challenges that inhibit antimicrobial penetration and
activity.