The Journal of Bone and Joint Surgery, Vol 63, Issue 5 798-804, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
The depot administration of penicillin G and gentamicin in acrylic bone cement
SF Hoff, RH Fitzgerald and PJ Kelly
The in vitro elution of penicillin and gentamicin from
polymethylmethacrylate was studied qualitatively and quantitatively.
Penicillin eluted poorly from Simplex P. Higher levels of penicillin eluted
in sustained fashion from Palacos; concentrations of one microgram or more
per gram of cement were recorded during the thirteen weeks of observation.
Although the in vitro leaching of gentamicin from Palacos cement was
similar to that of penicillin, there were two important differences: (1)
most of the gentamicin leaching from the Palacos did so within the first
twenty-four hours, and (2) the concentrations decreased to less than one
microgram per gram of cement after the sixth week of observation. The in
vivo elutions of penicillin and gentamicin from Palacos were studied in
canine femora. The concentrations of penicillin and gentamicin in the
endosteal bone at the bone-cement interface exceeded the concentrations
found after intravenous administration of either agent. Bactericidal
concentrations of gentamicin in osseous tissue persisted for seven months
after implantation. Peak concentrations in serum following the depot
administration of either penicillin or gentamicin occurred within thirty
minutes of implantation. Concentrations of gentamicin in serum did not
approach toxic levels. These data suggest that a high concentration of
either penicillin or gentamicin can be obtained at the bone-cement
interface--one of the vulnerable sites in total joint arthroplasty--for a
prolonged period with the depot administration of these agents in acrylic
bone cement. These osseous concentrations can be achieved without exposing
the patient to elevated levels in serum and their potential toxic side
effects.
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