Liquid gentamicin and vancomycin in bone cement: a potentially more cost-effective regimen

J Arthroplasty. 2009 Jan;24(1):125-30. doi: 10.1016/j.arth.2008.01.131. Epub 2008 Feb 14.

Abstract

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.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / pharmacology
  • Arthroplasty / methods
  • Bone Cements*
  • Cost-Benefit Analysis
  • Drug Delivery Systems / methods
  • Gentamicins / administration & dosage*
  • Gentamicins / economics*
  • Gentamicins / pharmacology
  • Humans
  • Materials Testing
  • Polymethyl Methacrylate
  • Pseudomonas Infections / prevention & control
  • Pseudomonas aeruginosa / drug effects
  • Pseudomonas aeruginosa / growth & development
  • Vancomycin / administration & dosage*
  • Vancomycin / economics*
  • Vancomycin / pharmacology

Substances

  • Anti-Bacterial Agents
  • Bone Cements
  • Gentamicins
  • Vancomycin
  • Polymethyl Methacrylate