JAC Advance Access published online on December 19, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh032
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Medicine
and Public Health, Unit of Pharmacology, Policlinico G.B. Rossi,
37134 Verona;
* Corresponding author. E-mail: elisa.bertazzoni{at}univr.it.
Received 4 July 2003
; revised 10 October 2003
; accepted 14 October 2003
Aim: Evaluation of the delivery of
gentamicin and vancomycin from polymethylmethacrylate (PMMA) spacers before
and after implantation for the treatment of total hip replacement
infections. Methods: Twenty industrially produced spacers
containing gentamicin (1.9%) were utilized. Vancomycin (2.5%)
mixed with PMMA cement was used to fill holes drilled in the cement
of 14 of the 20 spacers immediately before implantation. The spacers
were removed from 20 patients 3-6 months after implantation
and then immersed in phosphate buffer at 37°C
for 10 days. Antibiotic concentrations were determined by fluorescence
polarization immunoassay. Results: Gentamicin and vancomycin were still
present in all the spacers removed from the patients. The release
of gentamicin alone and in combination with vancomycin was in the
range 0.05%-0.4% of the initial amount
present, whereas the release of vancomycin was in the range 0.8%-3.3%.
The release kinetics showed a similar pattern for both drugs. After
a high initial release of drug, a reduced, but constant, elution was
observed over the next few days. Conclusions: The delivery of gentamicin and
vancomycin from PMMA cement was high initially, with sustained release
over several months. Incorporation of vancomycin into the surface
of the spacers permitted spacers to be prepared with multiple antibiotics
present and without adversely affecting the release kinetics of
the agents. The gentamicin-vancomycin combination shows
potential for the treatment of infection following total hip replacement
in specific patients.
Keywords: antibiotic combination, antibiotic-loaded cement,
drug delivery system, surgical wound infection, topical administration
Release of gentamicin and vancomycin from temporary
human hip spacers in two-stage revision of infected arthroplasty
2 Department
of Biomedical and Surgical Sciences, Orthopaedic Clinic, University
of Verona, Verona, Italy
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