Prophylactic use of antibiotic bone cement: an emerging standard--in opposition.
Antibiotic-loaded bone cement (ABLC) is an effective delivery method of local antibiotics. ABLC for treatment should be high dose (>3.6 g per 40 g cement) for beads or spacers and 1 to 2 g antibiotic per 40 g cement for prosthesis fixation. Multiple antibiotics are required for treatment, with antibiotics being individualized according to culture susceptibilities. This approach requires hand mixing because there are no commercial high-dose products. ABLC should be low dose (< or =1 g per 40 g cement) for prophylaxis purposes. Concerns with toxicity and cement mechanical properties are inconsequential with low-dose ABLC. Available clinical evidence supports low-dose ABLC for prophylaxis in revisions and high-risk primary joints, but concerns of emerging drug-resistant organisms probably outweigh routine use of low-dose ABLC in all uncomplicated primary arthroplasties.
Hanssen
Arlen D
AD
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements; D018890:Chemoprevention / Q000379:methods; D002986:Clinical Trials as Topic; D016503:Drug Delivery Systems / Q000379:methods*; D004342:Drug Hypersensitivity; D004351:Drug Resistance; D006801:Humans; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D012086:Reoperation
D000900:Anti-Bacterial Agents; D001843:Bone Cements