Gentamicin-PMMA chains are an effective drug delivery system for local
antibiotic therapy in bone and
soft-tissue infections. The
gentamicin concentrations at the site of
infection are far higher than after systemic application of the same
antibiotic and far above the minimal inhibitory concentrations of most common pathogens. Because of the very low concentrations in the serum and urine after implantation of the
antibiotic bead chains, toxic side effects are not to be feared. Radical
debridement with removal of all sequestrated bone fragments and removal of all alloplastic implants is mandatory before implantation of
gentamicin-PMMA chains into the infected bone cavity. Primary
wound closure is necessary to achieve high local concentrations. The chains can be used for temporary or permanent filling of osteomyelitic cavities. Guidelines are given for the clinical application in sequestrating
osteomyelitis, infected osteosynthesis, and infected
pseudarthrosis. There are distinct advantages of this new form of
antibiotic therapy in chronic
osteomyelitis, such as increased patient comfort by primary
wound closure, no need for prolonged systemic
antibiotic therapy with toxic side effects, no irrigation-
suction-drainage,
early ambulation, shortening of hospitalization, and reduced cost.