Clinicians have been using PRF and other platelet concentration products with the regenerative procedure in order to enhance the healing and to reduce the postoperative complications (34), however, studies have shown that PRF have only mild antibacterial activity against some bacterial agents like S. aureus, and it is not affective against resistance bacteria like F. Nucleatum (35, 36). Moreover, the most frequent postoperative complication in minor surgery is infection due to the exposure of the flap (or membrane) and the bacterial colonization of the wound (22, 37).
Therefore, this research aimed to improve the antibacterial activity of PRF by adding different forms of antibiotics and developing a protocol for the preparation of antibiotic releasing biomaterial (ARB) based on platelet rich fibrin (PRF), which will help to overcome the infection after minor surgery procedure.
Local ARB can be effective where infection is predictable, and can reduce the use of antibiotic especially in the field of dental surgeries (38), and also, eliminating the side effect of using systematic antibiotic (cell toxicity, and antibiotic resistance) (39).
Several studies tried to improve the PRF, one study added silver nanoparticles (SNP) which created SNP modified PRF, and this study concluded that SNP modified PRF had an improved mechanical properties and higher antimicrobial activity (21), other study evaluated release kinetics of different antibiotic from PRF, the results showed that PRF could release antibiotics for a week (40).
The two bacteria chosen in this research are S. aureus, and E. faecalis because of their well-known roll to cause infection (41, 42), also, they are a major cause of hospital wound infection (43), both bacteria were isolated from pediatric blood infection from Damascus children Hospital.
Three forms of antibiotic agent were used in this research, and the research showed that adding ampoule or solution form can significantly increase the antibiotic activity of PRF, compared with normal PRF (control), and ARB could release antibiotic for 10 days. on the other hand, powder form failed to improve PRF, this might be because antibiotic in powder form changed the osmotic pressure of the blood resulting in cells desolation. No significant difference between ampoule and solution form was noticed, however, ampoule had higher results, this can be explained because ampoule is already prepared for IV, IM injection while the solution concentration may have been diluted in the serum. No previous study had studied the effect of pharmaceutical form on the antibiotic release of PRF.
0.5 ml and 1 ml volume had similar results, however, 0.5 ml had a slightly higher antibacterial activity, this result agrees with other study, because in the protocol used in the previous research, PRF has failed to form in 1 ml volume samples (20).
The antibiotic release in our study lasted for 10 days, other study recorded that the bacterial growth inhabitation lasted between 4–7 days (20, 40).
The concept of antibiotic releasing biomaterial (ARB) introduced in this research might have an important future clinical relevance with general practice, because infection of the surgical site remain the main complication after minor surgery (22). The use of ARB can have an important role in reducing infection which interfere with second intention healing after dermatologic surgery (44, 45) or after open fracture (46), and will be of great interest in oral surgeries and treating of periodontal diseases and overall eliminating surgical site infection by gradual local releasing of antibiotic (47).
We recommend further research of the protocol proposed in this study using different antibiotic agents and bacteria in order to prepare this concept for the clinical application.