Local antibiotic administration in osteomyelitis treatment--a comparative study with two different carrier substances

Two antibiotic carriers (collagen sponge/PMMA-beads--loaded with gentamicin) for the treatment of osteomyelitis of long bones are compared in a randomised prospective study of 20 patients in respect of efficacy, safety and biocompatibility. In addition, the concentration of gentamicin in serum, urine and wound exudate was measured. This revealed marked differences. Gentamicin was released rapidly from the collagen sponge, leading to high levels in wound exudate and urine within the first 48 hours, with measurable but non-toxic concentrations in the serum. The liberation of gentamicin from the PMMA beads was much slower. This resulted in low steady levels in wound exudate and urine, and no detectable concentrations in the serum. The clinical outcome showed no differences between both methods of application. In 80% of the collagen sponge group and in 90% of the PMMA-beads group the osteomyelitis was completely allayed with disappearance of all infectious parameters. The number of re-operations was significantly higher in the PMMA group. It is recommended to use collagen sponges for the local treatment of osteomyelitis in cases that can probably be eradicated in a single surgical procedure, whereas PMMA beads should be applied in larger defects requiring a space-occupying function for further reconstructive operations.