Local Antibacterial Therapy for the Management of Orthopaedic Infections
- 1 July 1995
- journal article
- review article
- Published by Springer Science and Business Media LLC in Clinical Pharmacokinetics
- Vol. 29 (1), 36-45
- https://doi.org/10.2165/00003088-199529010-00005
Abstract
Bone infection has long been a formidable foe of orthopaedic surgeons. The standard method of treating osteomyelitis generally consists of irrigation and debridement supplemented by pre- and postoperative antibiotics and intraoperative antimicrobial solutions. In the 1970s, Buchholz introduced the concept of local antibacterial therapy in the form of antibiotic impregnated bone cement to treated infected arthroplasties. From this, antibiotic impregnated beads were developed to treat local infections of bone and soft tissue. The advantage of these beads compared with parenteral therapy is that they deliver a high concentration of antibacterial locally while avoiding high systemic concentrations, thus avoiding adverse effects that are often associated with parenteral antibacterial therapy. Additionally, methylmethacrylate bone cement does not significantly affect the immune response of the body. This makes the use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads highly effective either as an alternative to, or in conjunction with, systemic antibiotic treatment of infected arthroplasties, and localised bone and soft tissue infection. This article explores the indications for the use of local therapy as well as any advantages or disadvantages it may have over systemic antibacterial treatment. Additionally, there are important pharmacokinetic considerations for the optimal use of antibacterial agents in the treatment of osteomyelitis.Keywords
This publication has 67 references indexed in Scilit:
- Comparative Study of Gentamicin Release from Normal and Low Viscosity Acrylic Bone CementClinical Pharmacokinetics, 1990
- In vitro measurement and computer modelling of the diffusion of antibiotic in bone cementJournal of Biomedical Engineering, 1986
- Leaching of tobramycin from PMMA bone cement beadsJournal of Biomedical Materials Research, 1985
- Influence of methyl methacrylate on quantitative gel diffusion assay of immunoglobulinsJournal of Biomedical Materials Research, 1979
- Tissue Reactin to Methyl Methacrylate Monomer:A Comparative Study in the Rabbit's Ear on the Toxicity of Methyl Methacrylate Monomer of Varying CompositionActa Orthopaedica, 1976
- Penicillin Combined with Gentamicin or Streptomycin: Synergism against EnterococciThe Journal of Infectious Diseases, 1971
- Charnley ???Low Friction Torque??? ArthroplastyPublished by Ovid Technologies (Wolters Kluwer Health) ,1971
- The Influence of Acrylic Cement: An Experimental StudyActa Orthopaedica, 1971
- Macrophage and Neutrophil Specific Chemotactic Factors in SerumNature, 1969
- Endogenous factors responsible for leucocytic emigration in vivoThe Journal of Pathology and Bacteriology, 1961