Antibacterial Agents Employed in Microneedles for the Management of Diabetic Ulcers: Review

Infected diabetic ulcers are one of the most serious complications of diabetes mellitus. Nearly, half of diabetic ulcers develop infections, and twenty percent of them require lower extremity amputation. Microneedles showed promising results in diagnostic and medical fields including diabetic ulcers. This is due to the painless and minimally intrusive nature of the drug delivery technique, which enhances patient acceptance and adherence to prescribed treatment plans and sustains ideal medication concentration at the wound site for a prolonged amount of time. Additionally, it aims to lessen systemic exposure and the associated negative effects by concentrating medication delivery on the wound site. Microneedles, despite not being clinically tested, have shown promising effects on wound healing in diabetic wounds. They have several beneficial properties, including the structural ability to be loaded with compounds like nanoparticles, stem cells, antibacterial agents, and nucleic acids, the ability to overcome physical barriers, the ability to deliver drugs on demand, mechanical stimulation that triggers collagen deposition and rearrangement, and the ability to overcome bacterial resistance and biofilms. Additionally, microneedles can monitor wound bed conditions like temperature, pH, proteins, and procreative oxygen species. This review addressed 33 pre-clinical studies that successfully loaded antibacterial agents to microneedles and the resulting consequences on animal models. Various antibacterial agents like metallic nanoparticles, antimicrobial peptides, Polymixin B, derivatives of Fluoroquinolones, and Tetracycline are among the agents that are showing promising results for further investigation. The most common types used in these studies are dissolving and hydrogel-forming. Further preclinical investigations and well-designed clinical trials are required to evaluate the efficacy and safety of microneedles as transdermal drug delivery devices for antibacterial agents in diabetic wounds.