Treatment of bone and soft-tissue infections with gentamicin-polymethyl-methacrylate chains. A review of clinical trials involving 1 500 cases.
In vitro and in vivo experimental work showed that gentamicin-polymethyl-methacrylate (G-PMMA) provides bactericidal gentamicin concentrations at the site of infection but very low systemic concentrations, suggesting advantages as regards infection control and lack of side-effects. During the past 4 years 1247 osteomyelitis patients have been treated with G-PMMA at 11 clinics. The early postoperative results showed control of infection in 90.8% of cases. Infection persisted in 9.2% owing to remaining sequestra, osteosynthetic material, etc. This indicates the importance of good and radical surgery. Follow-up of 355 patients for 3 - 54 months postoperatively showed relapses in only 27 cases. A total of 361 patients with soft-tissue infections (e.g. associated with bone infections, sacral cavity after rectum excision, abscesses, etc.) underwent treatment with G-PMMA after thorough debridement, with good results. Techniques for implantation, and removal of the chains are discussed. No adverse effects have been observed in this series of trials.
D000818:Animals; D001424:Bacterial Infections / Q000188:drug therapy*; D001847:Bone Diseases / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003240:Connective Tissue Diseases / Q000188:drug therapy*; D004285:Dogs; D004343:Drug Implants; D005839:Gentamicins / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D007700:Kinetics; D007902:Length of Stay; D008768:Methylmethacrylates / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*
D004343:Drug Implants; D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead