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The Journal of Bone and Joint Surgery (American) 83:1878-1890 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Antibiotic Therapy for Musculoskeletal Infections

Jon T. Mader, MD, Jue Wang, MD and Jason H. Calhoun, MD

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

Jon T. Mader, MD
Jue Wang, MD
Jason H. Calhoun, MD
Division of Infectious Diseases, Department of Internal Medicine (J.T.M.), and Department of Orthopaedics and Rehabilitation (J.T.M., J.W., and J.H.C.), University of Texas Medical Branch, Galveston, Texas 77555-1115. E-mail address for J.T. Mader: jtmader@utmb.edu. E-mail address for J. Wang: juewang@utmb.edu. E-mail address for J.H. Calhoun: jcalhoun@utmb.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy’s Annual Meeting, will be available in March 2002 in Instructional Course Lectures, Volume 51. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).


   Introduction
 
Antibiotics are grouped into categories on the basis of their mechanisms of action. These categories include cell-wall active antibiotics, ribosomal active antibiotics, RNA active antibiotics, DNA active antibiotics, antimetabolites, and the reducing compounds.


   Cell-Wall Active Antibiotics
 
The cell-wall active antibiotics include penicillins, β-lactamase inhibitors, cephalosporins, other β-lactam antibiotics, and vancomycin. β-lactamase inhibitors are combined with the penicillins to enhance the antibiotic activity against β-lactamase-producing organisms.

Penicillins
The penicillin class of antibiotics is frequently used for the treatment of musculoskeletal infections. The penicillins can be divided into general groups on the basis of their antibacterial activity. The major penicillin groups of interest to an orthopaedic surgeon are natural penicillins, aminopenicillins, penicillinase-resistant penicillins, antipseudomonal penicillins (carboxypenicillins), and extended spectrum penicillins (ureidopenicillins). There is overlap among these groups; the differences are usually pharmacological in nature.

The major side effects of all of the penicillins are hypersensitivity reactions that range in severity from a rash to anaphylaxis1. . . . [Full Text of this Article]


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