- vancomycin and addition of antibiotics to cement, and local delivery of antibiotics to infected joints):
- calcium sulfate:
- biologically inert osteoconductive material which serves as a temporary scaffold for osteoblasts;
- osteoset (wright medical technology):
- typically dissolves in one to two months;
- vancomycin: local pharmokinetics vs systemic:
- has much slower and more consitent elution characteristics than tobramycin and gent;
- vancomycin shows very poor tissue penetration, which is a disadvantage of IV infusion;
- in contrast, w/ local application there will also be reduced penetration from the implanted site into the vascular system,
which keeps local tissue levels high and systemic levels low;
- safety:
- vancomycin shows the least cytotoxic effect of all commonly used antibiotics and is not likely to cause systemic side effects
after local application;
- bactericidal activity and biofilm:
- vancomycin is one of the antibiotics with intracellular bactericidal activity and therefore should cover small colony variants
of staphylococci and MRSA;
- penetrates glycocalices very rapidly;
- once incorporated in biofilm Vancomycin shows a strain dependent bactericidal biofilm activity between 8 times and 128
times the MIC of planktonic bacteria;
- shows superior bactericidal activity against biofilm embedded staphylococci and MRSA compared with most other
antibiotics;
- references:
- Impact of biofilm on activity of vancomycin alone and in combination with tigecycline and rifampicin against Staph.
- Comparison of biofilm-associated cell survival following in vitro exposure of MRSA biofilms to the antibiotics
- Elution Characteristics:
- references:
- The levels of vancomycin in the blood and the wound after the local treatment of bone and soft-tissue infection with antibiotic-loaded calcium sulphate as carrier material
- The in vitro elution characteristics of vancomycin from calcium phosphate-calcium sulfate.
- Local release of antibiotics for surgical site infection management using high-purity Ca sulfate: an in vitro elution study.
- Size and composition of synthetic calcium sulfate beads influence dissolution and elution rates in vitro.
- The in vitro elution characteristics of vancomycin from calcium phosphate-calcium sulfate beads
- Preliminary in vitro evaluation of therapy for wound infection reduction: rapidly resorbing local antibiotic delivery.
- Antibiotic-loaded Ca sulfate beads for prevention of colonization and biofilm formation in periprosthetic infections.
- Effects of bead size and polymerization in PMMA bone cement on vancomycin release.
- General References:
- Calcium sulfates: what is the evidence?
- The Use of Calcium Sulfate Impregnated with Vanc in Treatment of Open Fractures of Long Bones: A Preliminary Study.
- The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases.
- Calcium Sulfate- and Calcium Phosphate-Based Bone Substitutes. Mimicry of the Mineral Phase of Bone
- 50 Years ago in CORR: The use of plaster of Paris to fill defects in bone Leonard F. Peltier, MD CORR 1961;21:1-31.
- References from Addition of Vancomycin to Bone Grafts: (see osteomyelitis and bone grafts)
- High active local levels of vancomycin without nephrotoxicity released from impacted bone allografts in 20 revision hip arthroplasties.
- Vancomycin-supplemented cancellous bone allografts in hip revision surgery.
- Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion.
- Cancellous bone as an antibiotic carrier
- Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. Two-stage revision results.
- Histology of vancomycin-supplemented impacted bone allografts in revision total hip arthroplasty
- Antibiotic-autogenic cancellous grafting is an effective method for management of infected tibial defects: a comparison study.
- Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion.
- In vitro release of vancomycin and tobramycin from impregnated human and bovine bone grafts.