title: Antimicrobial Formulations of Absorbable Bone Substitute Materials as Drug Carriers Based on Calcium Sulfate.
abstract: Substitution of bones is a well-established, necessary procedure to treat bone defects in trauma and orthopedic surgeries. For prevention or treatment of perioperative infection, the implantation of resorbable bone substitute materials carrying antibiotics is a necessary treatment. In this study, we investigated the newly formulated calcium-based resorbable bone substitute materials containing either gentamicin (CaSO4-G [Herafill-G]), vancomycin (CaSO4-V), or tobramycin (Osteoset). We characterized the released antibiotic concentration per unit. Bone substitute materials were implanted in bones of rabbits via a standardized surgical procedure. Clinical parameters and levels of the antibiotic-releasing materials in serum were determined. Local concentrations of antibiotics were measured using antimicrobial tests of bone tissue. Aminoglycoside release kinetics in vitro per square millimeter of bead surface showed the most prolonged release for gentamicin, followed by vancomycin and, with the fastest release, tobramycin. In vivo level in serum detected over 28 days was highest for gentamicin at 0.42 μg/ml, followed by vancomycin at 0.11 μg/ml and tobramycin at 0.04 μg/ml. The clinical parameters indicated high biocompatibility for materials used. None of the rabbits subjected to the procedure showed any adverse reaction. The highest availability of antibiotics at 14.8 μg/g on day 1 in the cortical tibia ex vivo was demonstrated for gentamicin, decreasing within 14 days. In the medulla, vancomycin showed a high level at 444 μg/g on day 1, decreasing continuously over 14 days, whereas gentamicin decreased faster within the initial 3 days. The compared antibiotic formulations varied significantly in release kinetics in serum as well as locally in medulla and cortex.
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Munich, Germany Dominik.Pfoerringer@mri.tum.de.
authors.forename: D
authors.initials: D
authors.lastname: Pförringer
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Obermeier
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kiokekli
authors.affiliation: Heraeus Medical GmbH, Wehrheim, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Büchner
authors.affiliation: Heraeus Medical GmbH, Wehrheim, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Vogt
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stemberger
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Burgkart
authors.affiliation: Klinikum rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Lucke
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000493:pharmacokinetics; D000890:Anti-Infective Agents / Q000737:chemistry / Q000493:pharmacokinetics*; D018786:Bone Substitutes / Q000737:chemistry*; D002133:Calcium Sulfate / Q000737:chemistry*; D004337:Drug Carriers / Q000737:chemistry*; D005260:Female; D005839:Gentamicins / Q000737:chemistry / Q000493:pharmacokinetics; D011817:Rabbits; D014031:Tobramycin / Q000737:chemistry / Q000493:pharmacokinetics; D014280:Triglycerides / Q000737:chemistry / Q000493:pharmacokinetics; D014640:Vancomycin / Q000737:chemistry / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D018786:Bone Substitutes; D004337:Drug Carriers; D005839:Gentamicins; D014280:Triglycerides; D014640:Vancomycin; C005859:tripalmitin; D014031:Tobramycin; D002133:Calcium Sulfate