Liquid gentamicin and vancomycin in bone cement: a potentially more cost-effective regimen.
This study investigated the use of liquid gentamicin, a much less costly antibiotic (<1/20 the price of tobramycin) with a broad antimicrobial spectrum, alone and in combination with vancomycin in bone cement. Standardized cement specimens loaded with 480 mg of liquid gentamicin, 4 g of powdered vancomycin, or both antibiotics were tested for elution characteristics, bioactivity, compressive strength, and porosity. Vancomycin elution was enhanced by 146% with the addition of gentamicin liquid, and gentamicin elution was enhanced by 45% when combined with vancomycin. Bioassay confirmed the bactericidal activity of the released antibiotics. Adding liquid gentamicin increased porosity, whereas adding vancomycin did not. Compressive strength decreased by 13%, 37%, and 45% in specimens containing vancomycin, liquid gentamicin, and both antibiotics, respectively. Despite inferior mechanical properties, the temporary nature of cement beads and spacers makes the liquid gentamicin-vancomycin mixture a potentially more cost-effective regimen in bone cement to treat musculoskeletal infections.
Department of Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Pang-Hsin
PH
Hsieh
Ching-Lung
CL
Tai
Po-Chen
PC
Lee
Yu-Han
YH
Chang
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics* / Q000494:pharmacology; D001178:Arthroplasty / Q000379:methods; D001843:Bone Cements; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems / Q000379:methods; D005839:Gentamicins / Q000008:administration & dosage* / Q000191:economics* / Q000494:pharmacology; D006801:Humans; D008422:Materials Testing; D019904:Polymethyl Methacrylate; D011552:Pseudomonas Infections / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development; D014640:Vancomycin / Q000008:administration & dosage* / Q000191:economics* / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D014640:Vancomycin; D019904:Polymethyl Methacrylate