Treatment of experimental osteomyelitis by surgical debridement and the implantation of bioerodable, polyanhydride-gentamicin beads.
Osteomyelitis was induced in the radius in 77 rabbits and confirmed by histological examination and culture. At 4 weeks, the wounds were debrided and the animals were treated with (a) fatty acid dimer-sebacic acid beads (a bioerodable composite) impregnated with 20% or (b) 10% gentamicin sulfate, (c) placebo beads and intramuscular gentamicin sulfate, (d) placebo beads alone, or (e) debridement only. After 4 weeks, eradication of infection was determined by histological examination and culture. Osteomyelitis was eradicated in 93% of the animals treated with the beads and 20% gentamicin, in 67% of those treated with the beads and 10% gentamicin, in 25% of those treated with placebo beads and intramuscular gentamicin, in 7% of those treated with placebo beads alone, and in 12.5% of those treated with debridement only (p values from < 0.001 to 0.02). Fatty acid dimer-sebacic acid beads with gentamicin were then implanted in noninfected rabbits, and gentamicin sulfate concentrations in bone, serum, urine, and wound exudate were measured. Gentamicin sulfate was detectable in bone for as long as 8 weeks after implantation. Levels as high as 4,746 micrograms/ml were present in the wound exudate for the first 7 days. Levels in the serum peaked at 1.03 micrograms/ml. Urine levels peaked at 135 micrograms/ml.
Nelson
C L
CL
Department of Orthopaedic Surgery, University of Arkansas Medical Sciences, Little Rock 72205, USA. cnelson@comdean2.uams.edu
Hickmon
S G
SG
Skinner
R A
RA
D000812:Anhydrides; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001673:Biodegradation, Environmental; D003646:Debridement; D005122:Exudates and Transudates / Q000378:metabolism; D005839:Gentamicins / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D007273:Injections, Intramuscular; D008863:Microspheres; D010019:Osteomyelitis / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D019736:Prostheses and Implants; D011817:Rabbits; D012272:Ribs / Q000378:metabolism
D000812:Anhydrides; D000900:Anti-Bacterial Agents; D005839:Gentamicins