Antibiotic Choice: The Synergistic Effect of Single vs Dual Antibiotics

This review summarizes single vs dual antibiotic cement literature, evaluating for synergistic activity with dual antibiotics. A systematic review was performed for literature regarding dual antibiotics in cement, identifying 13 studies to include for review. Many in vitro studies reported higher el...

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Bibliographic Details
Published in:The Journal of arthroplasty 2020-03, Vol.35 (3), p.S19-S23
Main Authors: Mohamed, Nequesha S., Wilkie, Wayne A., Remily, Ethan A., Nace, James, Delanois, Ronald E., Browne, James A.
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
antibiotic cement
antibiotic elution
antibiotic synergy
Bacteria
Bone Cements
dual antibiotic cement
dual antibiotics
Humans
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Summary:This review summarizes single vs dual antibiotic cement literature, evaluating for synergistic activity with dual antibiotics. A systematic review was performed for literature regarding dual antibiotics in cement, identifying 13 studies to include for review. Many in vitro studies reported higher elution from cement and/or improved bacteria inhibition with dual antibiotics, typically at higher dosages with a manual mixing technique. Limited clinical data from hip hemiarthroplasties and spacers demonstrated that dual antibiotics were associated with improved infection prevention and higher intra-articular antibiotic concentrations. In addition to broader pathogen coverage, several studies document synergy of elution and increased antibacterial activity when dual antibiotics are added to cement. Limited clinical evidence suggests that dual antibiotic cement may be associated with reduced infection rates.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2019.11.002