Tobramycin Blood Levels after Local Antibiotic Treatment of Bone and Soft Tissue Infection

Abstract

Local antibiotic delivery using different carriers plays an important role in both infection prophylaxis and treatment. Besides dead space management, these carriers have the advantage of providing a high concentration of local antibiotics with a lower risk of systemic toxicity. Few studies have reported on systemic toxicity associated with antibiotic-impregnated carriers. The present study investigates the systemic tobramycin concentration at 24, 48 and 72 h postoperatively after using tobramycin-loaded polymethyl methacrylate (PMMA) and calcium sulfate (CS) as local antibiotic carriers. Additionally, this work assesses the renal function postoperatively for indications of acute kidney injury (AKI). Fifty-two patients were treated in 58 procedures with tobramycin and vancomycin-loaded PMMA, CS, or both. All systemic tobramycin levels were <2 mcg/mL at 72 h, and the resulting rate of AKI was 12% (7/58). In conclusion, local tobramycin antibiotic delivery using PMMA, CS, or both remains a safe and effective modality in the treatment of osteomyelitis as long as the surgeon is aware of its possible nephrotoxic effect.

Efficacy of Infection Eradication in Antibiotic Cement-Coated Intramedullary Nails for Fracture-Related Infections, Nonunions, and Fusions

“…Antibiotic management was directed by the infectious disease consultant. The combination of local vancomycin and tobramycin is favored in the treatment of osteomyelitis [ 25 ]. Chemical prophylaxis for venous thromboembolus was used for 6 weeks.…”

Progress on Electrochemical Sensing of Pharmaceutical Drugs in Complex Biofluids

“…Drugs to suppress seizures in the treatment of epilepsy Carbamazepine Highly variable pharmacokinetics; strong interactions with other common drugs; and/or high toxicity [13,14] Drugs to treat bacterial or fungal infections Tobramycin; vancomycin; levofloxacin; rifampicin; azithromycin; sulfanilamide; trimethoprim; ketoconazole Potential for kidney injury for tobramycin [29] Drugs to treat Parkinson's disease Apomorphine; levodopa Side effects of nausea for apomorphine [30] and decreased efficacy and increased motor disturbances with use for levodopa [31] Drugs to treat depression Paroxetine; benzodiazepines Highly variable pharmacokinetics with a longer time for clearance with aging and renal/hepatic damage for paroxetine [26] Drugs to treat cancer Methotrexate; doxorubicin; dasatinib; epirubicin; cyproterone acetate; regorafenib; interferon gamma Pulmonary and hepatotoxicity for methotrexate [32]; cardiotoxicity for doxorubicin [33]; adverse effects include dyspnea, fatigue, nausea for dasatinib [34]; hepatotoxicity for epirubicin [35]; hepatotoxicity for cyproterone acetate [36]; adverse effects include dyspnea, fatigue, nausea for regorafenib [37] Table 1. Cont.…”

Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment

“…185 The current research on antibiotic-loaded PMMA cement is much more advanced than anti-tumor treatment, so many research insights can be applied to anti-tumor treatment. 186,187…”

“…185 The current research on antibiotic-loaded PMMA cement is much more advanced than anti-tumor treatment, so many research insights can be applied to anti-tumor treatment. 186,187 Generally, PMMA powder is initially mixed with antineoplastic agents, including methotrexate (MTX), doxorubicin (DOX), ZA, and cisplatin, before being incorporated into the liquid component. 45,161,163 On a few occasions, the drug was firstly compounded with the liquid component.…”