5 local antibiotics rfi
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Local Antimicrobial Strategies in
Fracture Related Infection
H. D. Thai
N. V. Nhuan
16 Sep 2023 – HCM city
Pathophysiology of Osteomyelitis
Pathophysiology of Osteomyelitis
Bacteria
OSTEOMYELITIS
Necrotic
Tissue
Foreign
Bodies
Pathophysiology of Osteomyelitis
Bacteria
Irrigation
Bacteria
OSTEOMYELITIS
Necrotic
Tissue
Foreign
Bodies
Debridement
Delivery of Antibiotics
Antibiotic characteristics for Local Use
• Broad-spectrum antibiotic
• Compatible with carrier
• Adequate release
• No deterioration of carrier streghth
• Toxicity
Local antibiotics and Recommended Local Dosages
Minimum
Dose
Maximum
Dose
Toxicity
Gentamicin
0.4 g
4.8 g
Nephrotoxicity, ototoxicity
Vancomycin
2g
6g
Nephrotoxicity, neutropenia
Tobramycin
1.2 g
4.8 g
Nephrotoxicity, neurotoxicity
0.5 g + 2 g
4.8 g + 4 g
Genta + Vanco
Antibiotic – loaded carriers release
Antibiotic – loaded carriers release
Take home messages
• Debridement is keystone before using local antimicrobial
• Antibiotic: type, dosage, mixing method
• PMMA: carrier for antibiotics – spacer, bead, coating
