Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Abstract

Cutibacterium acnes (C. acnes) is a significant insidious pathogen for postoperative infections in shoulder surgery. Studies have demonstrated that certain topical antibiotic powders used have the potential for chondrotoxicity. Benzylpenicillin, commonly referred to as Penicillin G (Pen G) has the lowest minimum inhibitory concentration (MIC) for C. acnes. There is no research regarding the topical application of Pen G during shoulder surgery, nor has its chondrocyte toxicity been previously investigated. This study sought to characterize the in vitro chondrocyte toxicity of Pen G. Culture‐derived bovine chondrocytes were exposed to serial Pen G concentrations and compared with a positive and negative control. A negative control of growth medium and positive control of 1% Triton solution. The chondrocyte viability was assessed via spectrophotometer absorbance. The treatment groups were analyzed using one‐way repeated measures analysis of variance and Pearson's correlation analysis. The chondrocyte viability was significantly higher for all Pen G concentrations as compared with the positive control (p < 0.001). All concentrations of Pen G exhibited continued chondrocyte metabolic activity over time. Analysis of variance, independent of time, demonstrated no significant decrease in chondrocyte viability for Pen G concentrations ≤6.25 mg/ml, as compared with the negative control (p > 0.05). Pen G demonstrated a significant negative correlation with its concentration and absorbance (r = 0.371, p < 0.001), however, concentrations ≤6.25 mg/ml did not demonstrate a significant decrease in chondrocyte viability (p = 0.063). Pen G in concentrations appropriate for C. acnes is not significantly chondrotoxic and may be safe for intrawound application. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:726‐730, 2020

Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and Their Systematic Association with Chondrolysis

“…26 Penicillin G, at dosages ranging from 0.39 -100 mg/mL in bovine and equine models, also demonstrated dose-dependent chondrotoxicity, as indicated by diminished detection of mitochondrial dehydrogenases and less viable cells detected with trypan blue exclusion staining. 20,27 Cephalosporins. From the four included studies on the cephalosporin class, cefazolin doses ranging from 0.39 to 50 mg/mL demonstrated dose-dependent chondrotoxicity.…”

“…20,26,30,31,35 This dose-dependent chondrotoxicity was also present for all studies on the cephalosporins cefazolin and ceftazidime and for one of two studies on the cephalosporin ceftriaxone. 20,26,28 Dose-dependent chondrotoxicity was also noted for ampicillin-sulbactam and penicillin G. 20,26,27 Based on these studies, the IA use of these antibiotics should be avoided, although studies in human models would be useful to validate these findings.…”

Design of antibacterial apatitic composite cement loaded with Ciprofloxacin: Investigations on the physicochemical Properties, release Kinetics, and antibacterial activity

“…The most effective treatment of bone infections is only achieved when the local antibiotic concentration remains above the minimum inhibitory concentration for an extended period, which often could not be provided by the conventional route of antibiotic administration (Rao et al, 2011;Wu et al, 2019). Hence, the potential of local antibiotic therapy which is a novel approach that allows relatively high concentrations of antibiotics ensures an easy access of the drug into the diseased site by inhibiting bacterial growth (Nadig et al, 2020;Nandi et al, 2016). Therefore, materials that function as bone substitutes and carriers for local drug delivery to the site of a defect are in high demand in orthopedics.…”