Elution characteristics of vancomycin and tobramycin combined in acrylic bone—cement

Penner, Murray; Masri, Bassam A.; Duncan, Clivе P.

doi:10.1016/s0883-5403(96)80135-5

Cited by 299 publications

(215 citation statements)

References 24 publications

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“…When the total cumulative antibiotic elution (total amount of antibiotic eluted through 21 days) is taken in consideration, there 35 was a 40% increase in metronidazole elution and a 118% increase in gentamicin elution from the MET/GENT beads compared with the beads containing each antibiotic individually. These results support the findings of an earlier report indicating that a combination of tobramycin and vancomycin in bone cement improved the elution rate of each antibiotic by 68% and 103% respectively (Penner 1996), but are contrasted with the finding that combination of tobramycin and oxacillin resulted in increased elution of tobramycin but decreased elution of oxacillin (Tripell 1986). Kuechle et al reported that elution rates that resulted from the combination of vancomycin and amikacin in PMMA were similar to rates obtained from AIPMMA with the antibiotics polymerized individually (Kuechle 1991).…”

Section: Discussionsupporting

confidence: 89%

“…Similar mechanisms may be responsible for the dose-dependent increase in metronidazole elution observed in the present study and for other antibiotics in previous studies Baker 1988;Calhoun 1989). In addition to the benefit of improved rates of elution, a combination of two antibiotics in AIPMMA beads should result in an improved antibiotic spectrum (Penner 1996).…”

Section: Discussionsupporting

confidence: 84%

“…In the present study, the amount of metronidazole and gentamicin in PMMA remained constant for the MET 20:1 and GENT groups compared with the MET/GENT group; as a consequence however, the overall ratio of PMMA to antibiotic powder was reduced from 20:1 to approximately 10:1. Perhaps, the increased elution of antibiotics from the MET/GENT group was attributable to increased porosity of the AIPMMA composite due to increased antibiotic content, as has been previously suggested Calhoun 1989;Kuechle 1991;Penner 1996). Similar mechanisms may be responsible for the dose-dependent increase in metronidazole elution observed in the present study and for other antibiotics in previous studies Baker 1988;Calhoun 1989).…”

Section: Discussionsupporting

confidence: 83%

“…However, it has been proposed that temperature has little effect on rate of antibiotic elution from PMMA. This was suggested by Penner et al, who performed elution studies at room temperature (21°C) in the search of project simplicity and their results were comparable to those obtained in other studies (Penner 1996).…”

Section: Discussionsupporting

confidence: 79%

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Elution of Metronidazole and Gentamicin from Polymethylmethacrylate Beads

et al. 2003

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(ABSTRACT)Ten polymethylmethacrylate (PMMA) beads containing metronidazole (3 concentrations); gentamicin sulfate; or metronidazole and gentamicin sulfate were immersed in 5 ml of phosphate buffered saline in triplicate. Eluent was replaced at specified time intervals for 1 day (1, 3, 6, 12 and 24 hours), daily, or weekly for 21 days.Antibiotic concentrations were measured by High Performance Liquid Chromatography.Changes in antibiotic bioactivity attributable to polymerization or co-polymerization of the antibiotics with PMMA, ethylene oxide sterilization, and storage of antibioticimpregnated PMMA (AIPMMA) beads containing metronidazole were evaluated.Antibiotic elution patterns were similar for all groups. Day-1 elution for groups containing either metronidazole (3 concentrations) or gentamicin represented a mean 63% to 66% and 79% respectively of the 21-day total elution. Approximately 50% of the day-1 elution occurred during the first hour. The elution of metronidazole was dosedependent. There was no significant difference in the total amount of antibiotic eluted from groups that had the saline changed daily versus weekly. The elution of metronidazole (day 3-21) and gentamicin (all days) was significantly greater when metronidazole and gentamicin were combined (p<0.05). Polymerization of PMMA was delayed in groups containing metronidazole.Neither polymerization nor copolymerization of metronidazole and gentamicin with PMMA, gas-sterilization, or 2-month storage of beads containing metronidazole significantly affected antimicrobial bioactivity.Metronidazole elutes from PMMA. The frequency at which the saline was changed did not affect the rate of antibiotic elution.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 79%

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Elution of Metronidazole and Gentamicin from Polymethylmethacrylate Beads

et al. 2003

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“…The use of two antibiotics results in a synergistic effect and the release of the individual components is greater than that of the single antibiotics on their own [2,6,29,31]. In our study, however, the addition of vancomycin did not result in an increase in the release of the antibiotics present in Copal bone cement, namely, gentamicin and clindamycin.…”

Section: Discussioncontrasting

confidence: 53%

Sufficient Release of Antibiotic by a Spacer 6 Weeks after Implantation in Two-stage Revision of Infected Hip Prostheses

Fink

Vogt

Reinsch

et al. 2011

Clinical Orthopaedics &Amp; Related Research

105

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Background Although antibiotic-loaded spacers are commonly used to treat periprosthetic infections, it is unclear whether spacers continue to release bactericidal levels of antibiotic 6 weeks after implantation. Questions/purposes We asked whether an antibiotic can be detected in the tissue surrounding the spacer 6 weeks after implantation and whether the concentration is higher than the minimal inhibition concentration (MIC) previously determined for pathogens that are responsible for most periprosthetic infections. Methods We removed 14 spacers used in two-stage septic revisions of infected hip prostheses 6 weeks after the primary implantations and determined the concentration of the antibiotics in the membrane formed between the spacer and the neighboring bone on the acetabular and the femoral sides. In seven cases Copal cement with gentamicin and clindamycin were used, and in seven other cases vancomycin was added to the Copal cement. Concentrations of the spacer antibiotics in the neighboring tissue were determined by tandem mass spectroscopy. Results All three antibiotics were detected in concentrations higher than their MIC. There were no differences between the groups regardless whether vancomycin was added to the cement, or whether the cement was applied with the acetabular cup spacer or with the stem spacer. Conclusions We concluded that, using the spacer technique described in this study, 6 weeks after spacer implantation, the concentrations of antibiotic are sufficient to treat a periprosthetic infection.

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Influence of isostatic compression on the stability of vancomycin loaded with a calcium phosphate-implantable drug delivery device

Gautier

Caillon²,

Ray

et al. 2000

J. Biomed. Mater. Res.

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It is essential to prevent microbial infections after osteoarticular trauma or prosthesis implantation. As an alternative to antibiotic parenteral administration, antibiotic-loaded biomaterials allow high concentrations to be obtained in situ without systemic toxicity. Although the formulation of biphasic calcium-phosphate (BCP)-vancomycin granules by isostatic compression has recently been used to produce drug-delivery devices, the stability of vancomycin needs to be proven. In this study, vancomycin was associated with BCP powders by isostatic compression at 100, 140, or 200 MPa and then extracted or released by a rotating paddle system for 24 h. Vancomycin assays were performed by spectrophotometric and microbiological methods. The results show that all vancomycin associated with the material was recovered after extraction without degradation. Thus, vancomycin was not denaturated after application of 100, 140, or 200 MPa of isostatic compression. The results for vancomycin released from granules compressed at the three pressures were not significantly different (p =.01) whether assays were performed microbiologically or spectrophotometrically, indicating a good correlation between the two methods. This process involving high pressure appears to be a good means of developing drug delivery devices loaded with therapeutic agents without denaturating the components.

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Elution characteristics of vancomycin and tobramycin combined in acrylic bone—cement

Cited by 299 publications

References 24 publications

Elution of Metronidazole and Gentamicin from Polymethylmethacrylate Beads

Elution of Metronidazole and Gentamicin from Polymethylmethacrylate Beads

Sufficient Release of Antibiotic by a Spacer 6 Weeks after Implantation in Two-stage Revision of Infected Hip Prostheses

Influence of isostatic compression on the stability of vancomycin loaded with a calcium phosphate-implantable drug delivery device

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