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In vitro elution of ciprofloxacin from polymethylmethacrylate cement beads
F R DiMaio1, J J O'Halloran, J M Quale
1Department of Orthopaedic Surgery and Rehabilitation, S.U.N.Y. Health Science Center, Brooklyn.
Abstract:
The use of antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads for the local delivery of antibiotics in the treatment of chronic osteomyelitis has become a standard orthopaedic practice. The increasing resistance to antibiotics of organisms associated with orthopaedic infections has led to interest in the incorporation of more effective antibiotics into PMMA cement. Ciprofloxacin, a synthetic fluoroquinolone, is potent against a broad spectrum of bacteria associated with osteomyelitis. In this study, strands of ciprofloxacin-impregnated PMMA cement beads were prepared with 0.2, 0.5, or 1.0 g of ciprofloxacin per 40 g of PMMA. The elution concentration of ciprofloxacin was at least 1-2 mcg/ml for 7 days (0.2 g), 30 days (0.5 g), and 42 days (1.0 g). This concentration is equivalent to the minimum inhibitory concentration for the common pathogens associated with osteomyelitis. Concurrent systemic and local ciprofloxacin therapy appears to be a method for the treatment of chronic osteomyelitis.
Insights
Ciprofloxacin-impregnated polymethylmethacrylate (PMMA) beads offer effective local antibiotic delivery for chronic osteomyelitis. Higher ciprofloxacin concentrations in PMMA beads prolong elution, maintaining therapeutic levels against resistant bacteria.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Materials Science
Background:
- Chronic osteomyelitis treatment often involves antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads.
- Increasing antibiotic resistance necessitates novel therapeutic strategies for orthopaedic infections.
- Fluoroquinolones, like ciprofloxacin, show broad-spectrum efficacy against osteomyelitis pathogens.
Purpose of the Study:
- To evaluate the elution characteristics of ciprofloxacin from PMMA cement beads.
- To determine if ciprofloxacin-PMMA beads can maintain minimum inhibitory concentrations (MIC) against osteomyelitis pathogens.
- To assess the potential of combined local and systemic ciprofloxacin therapy for chronic osteomyelitis.
Main Methods:
- Preparation of PMMA cement beads with varying ciprofloxacin concentrations (0.2, 0.5, 1.0 g per 40 g PMMA).
- Measurement of ciprofloxacin elution concentrations over time.
- Comparison of eluted concentrations with MICs for common osteomyelitis pathogens.
Main Results:
- Ciprofloxacin elution concentrations of 1-2 mcg/ml were sustained for 7 days (0.2 g), 30 days (0.5 g), and 42 days (1.0 g).
- Eluted concentrations met or exceeded the MIC for key pathogens.
- The study demonstrated sustained release of therapeutic levels of ciprofloxacin.
Conclusions:
- Ciprofloxacin-impregnated PMMA beads provide effective local antibiotic delivery for chronic osteomyelitis.
- Sustained elution profiles support the use of these beads in treating resistant infections.
- Concurrent systemic and local ciprofloxacin therapy is a promising treatment approach.