Release of antibiotics from polymethylmethacrylate cement

The increase in resistance rates to antibiotics of bacteria isolated from infected hip joints, particularly staphylococci, prompted us to investigate the usefulness of antibiotic combinations such as gentamicin plus vancomycin. Cylinder test specimens of polymethylmethacrylate (PMMA) cement (Cemex®, Tecres) containing gentamicin, vancomycin alone and in combination were studied. The antibiotic concentrations were determined using a microbiological method and fluorescence polarisation immunoassay (FPIA). The release of gentamicin, vancomycin alone and in combination from PMMA cement was prompt. The combination revealed a synergistic antimicrobial activity against E. coli and E. faecalis. Different gentamicin and vancomycin delivery rates from PMMA cement were demonstrated by FPIA. Gentamicin alone and in combination with vancomycin presented similar release rates from PMMA cement (1.50%). Vancomycin release from PMMA cylinders impregnated with the combination was lower (0.51%) than that from cylinders with vancomycin alone (1.16%). Vancomycin showed a 34.1% loss of microbiological activity at 37°C after ten days of incubation; the reduction corresponded to 15.0% when measured by FPIA. Results obtained with test specimens are indicative for the preparation of antibiotic-impregnated cements for different human prostheses