Gentamicin Release from Bone Cement: A Comparative Study between Hand Made Liquid & Powder Gentamicin beads

Abstract

Background and Purpose: Gentamicin beads are widely used in treatment of bone and joint infections. The
commercial form is expensive and may be unavailable in most hospitals in Thailand. Most orthopaedic surgeons
make them from gentamicin and powdered bone cement, but this still has high costs. In this study, the author
used liquid gentamicin, which was used regularly in intravenous route, to mix in bone cement and compare
gentamicin release between handmade liquid and powder gentamicin beads.
Methods: A prospective randomized clinical trial in patients with bone and joint infections from bacterial
causes in Hatyai Hospital. Patients were divided into liquid gentamicin and powder gentamicin groups.
Gentamicin concentration in surgical areas were collected, compared, and analyzed.
Results: Thirty patients in each group who had bacterial bone and joint infections were treated with bone
debridement and gentamicin beads were placed in surgical area. The liquid gentamicin group resulted in
significantly higher levels than in the powder group. Both groups had gentamicin levels many times higher than
the minimal inhibitory concentration (MIC) and persisted for at least 28 days. Clinical results of both groups
were excellent and no renal toxicity was observed.
Conclusions: The liquid gentamicin group had more antibiotic released to the surgical area than the powder
group, no renal toxicity detected, and appears to be cost-effective in the treatment of bacterial bone and joint
infections.