Elution of Metronidazole and Gentamicin from Polymethylmethacrylate Beads
Ten polymethylmethacrylate (PMMA) beads containing metronidazole (3 concentrations); gentamicin sulfate; or metronidazole and gentamicin sulfate were immersed in 5 ml of phosphate buffered saline in triplicate. Eluent was replaced at specified time intervals for 1 day (1, 3, 6, 12 and 24 hours), daily, or weekly for 21 days. Antibiotic concentrations were measured by high performance liquid chromatography. Changes in antibiotic bioactivity attributable to polymerization or co-polymerization of the antibiotics with PMMA, ethylene oxide sterilization, and storage of antibiotic-impregnated PMMA (AIPMMA) beads containing metronidazole were evaluated.
Antibiotic elution patterns were similar for all groups. Day-1 elution for groups containing either metronidazole (3 concentrations) or gentamicin represented a mean 63% to 66% and 79% respectively of the 21-day total elution. Approximately 50% of the day-1 elution occurred during the first hour. The elution of metronidazole was dose-dependent. There was no significant difference in the total amount of antibiotic eluted from groups that had the saline changed daily versus weekly. The elution of metronidazole (day 3-21) and gentamicin (all days) was significantly greater when metronidazole and gentamicin were combined (p<0.05). Polymerization of PMMA was delayed in groups containing metronidazole. Neither polymerization nor co-polymerization of metronidazole and gentamicin with PMMA, gas-sterilization, or 2-month storage of beads containing metronidazole significantly affected antimicrobial bioactivity.
Metronidazole elutes from PMMA. The frequency at which the saline was changed did not affect the rate of antibiotic elution. Co-polymerization of metronidazole and gentamicin sulfate in PMMA resulted in increased rates of elution. Intra-operative preparation of metronidazole-impregnated PMMA beads is not practical. However, prefabrication of metronidazole or metronidazole-gentamicin beads, gas-sterilization and storage for up to 2 months should not affect the efficacy of either antibiotic. The local delivery of biologically active metronidazole and gentamicin by elution from PMMA is feasible.