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Bacterial colonies in vivo develop biofilms that are hard to treat with oral/systemic antibiotics because their extracellular matrices - and, of course, the bacteria themselves - become resistant. I am writing this question with respect to Hidradenitis Suppurativa, a chronic disease that causes persistant lesions of bacterial infection.

My question is, why not inject an antibiotic, such as gentamycin, locally: directly into a lesion, ensuring it penetrates the matrix?

I have done lots of research but have found almost nothing supporting the idea of injecting an antibiotic locally; most articles and journals relate to filler injections (botox) gone wrong.

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I think you are imagining a biofilm to be like castle walls; once you've breached the walls, you have free access to the inside.

A biofilm is more like a gelatin dessert. Even if you have a biofilm that is large enough to inject into, it will still be a barrier to free movement of the drug.

There certainly is interest in local antibiotic delivery, the simplest of which is topical application, but it won't work quite the way I think you're envisioning it.

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  • I get what you're saying, but I invisioned an injection rupturing the cells of half of the bacteria, and rendering their defences useless. I was imagining injecting a lesion of around 1 cubic centemetre 4 to 5 times.
    – Ben
    Jan 23 at 20:10
  • @Ben I suspect that would result in a lot of inflammation rather than resolving any infection. A normal injection just won't lyse a bunch of bacterial cells like that. You're pretty much talking about a surgical intervention at that point, so why not just excise the lesion? Jan 23 at 20:12
  • @Ben As far as I know, surgical excision is standard when antibiotics or other pharmacological treatment are not sufficient. I see no logical reason why your suggested approach would be better. Jan 23 at 20:20

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