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Biocompatibility, biodegradation, good sorption characteristics, and unique structure of highly oxidized bacterial cellulose (OBC) are of great interest for the development of new drug delivery systems. In this study, OBC with 9.6, 13.0 and 19.5% carboxyl groups for 5, 20, and 48 h of synthesis, respectively, was successfully obtained using the HNO3/H3PO4–NaNO2. The results of morphological analysis showed that with an increase in the number of carboxyl groups, OBC fibers become thicker and rougher. Fourier-transform infrared spectroscopy showed the formation of carboxyl groups in the OBC after the oxidation reaction. The crystallinity of the samples according to X-Ray diffraction analysis decreased with increasing reaction time. The immobilization of cephalexin in the polymer matrix was studied in detail, it took 120 min to achieve balance in the solution with a concentration of 1 mg/ml, and the maximum amount of a sorbed antibiotic reached 43 mg/g. The drug release in vitro at 37 °C in PBS with pH 7.4 and 2.0 was prolonged. Various models were used to describe the release mechanism, the best of which was Ritger-Peppas with a diffusion exponent value ranging from 0.743 to 0.830, which explains the drug release mainly through non-Fickian diffusional release. The cephalexin-loaded OBC showed high antimicrobial activity against Gram-negative bacteria Escherichia coli and Gram-positive bacteria Staphylococcus aureus. The structure and properties of the resulting highly oxidized cellulose make it an excellent candidate as a drug delivery carrier with prolonged antimicrobial drug release characteristics.

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