Table 1.

Recommendations for antibiotic impregnation of acrylic bone cement spacers.

Pathogen organism/Indication	Antibiotic combination (per 40 g pack of PMMA)
methicillin-susceptible S. aureus	0.5 g gentamicin **+ 2 g vancomycin
methicillin-resistant S. aureus	0.5 g gentamicin** + 2 g vancomycin
methicillin-susceptible coagulase-negative Staphyloccoci	0.5 g gentamicin** + 2 g vancomycin
methicillin-resistant coagulase-negative Staphyloccoci	1 g gentamicin + 1 g clindamycin ** + 2 g vancomycin
Enterococci	0.5 g gentamicin** + 2 g vancomycin or 0.5 g gentamicin** + 0.8 g teicoplanin
E. coli	0.5 g gentamicin** + 2 g cefotaxime
Ps. aeruginosa	0.5 g gentamicin** + 2 g cefotaxime or 0.5 g gentamicin** + 2 g meropenem
Revision spacer surgery with spacer exchange due to infection persistence	1 g gentamicin + 1 g clindamycin ** + 2 g vancomycin (for gram-positive organisms) or + 2 g cefotaxime (for gram-negative organisms)
unknown	0.5 g gentamicin** + 2 g vancomycin

*= these recommendations are made based solely on the personal experience of the author over the past 15 years. **= industrial impregnated.