Antibiotic-impregnated beads. Part I: Bead implantation versus systemic therapy

Parenteral antibiotic therapy for acute bone infections, soft-tissue infections, and osteomyelitis may result in high serum concentrations associated with nephrotoxic, ototoxic, and allergic complications. Conversely, the local release of antibiotics into the wound with the use of antibiotic-impregnated cement or antibiotic-impregnated polymethylmethacrylate beads has been found effective and does not induce negative effects or result in systemic concentrations of clinical significance. The antibiotic-impregnated cement beads are fabricated on a surgical steel wire, and they have bimodal elution properties. They provide local antibiotic concentrations that surpass the minimum inhibitory concentrations for pathogens commonly isolated in orthopaedic infections. Their use effectively controls chronic osteomyelitis and acute musculoskeletal infections. Compared with systemic antibiotic therapy, the incidence of nephrotoxic, ototoxic, and hypersensitivity reactions is significantly diminished. The beads release 5% of the antibiotic within the first 24 hours. The sustained elution then progressively diminishes to undetectable levels within a few weeks or months.