Antibiotic bead chains.

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.