Table 2.
Dosage of antibiotics mixed in antibiotic-loaded bone cement (ALBC)
| Situation | Antimicrobial | Fixation cement (prophylactic dose: per 40 g PMMA cement) | Spacer cement (therapeutic dose: per 40 g PMMA cement) |
|---|---|---|---|
| Simple: industrially admixed antibiotics(italics: manually admixed antibiotics) | |||
| Standard situation | |||
| Susceptible or unknown pathogen(s) | Gentamicin + | 1 g | 1 g |
| Clindamycin | 1 g | 1 g (+ 2 g vancomycin) | |
| Special situations | |||
| Staphylococcus spp. (oxacillin-/methicillin-resistant) | Gentamicin + | 0.5 g | 0.5 g |
| Vancomycin or | 2 g | 2 g (+ 2 ga) | |
| Daptomycin | 2 g | 3 g | |
| Vancomycin-resistant enterococci (VRE) | Gentamicin + | 0.5 g | 0.5–1 g |
| Linezolid or | 1 g | 2 g | |
| Daptomycin or | 2 g | 3 g | |
| Fosfomycin sodiumb | 2 g | 2-4 g | |
| Resistant gram-negative pathogens (e.g., E. coli, Klebsiella, Enterobacter, Pseudomonas spp.) | Gentamicin + | 0.5 g | 0.5–1 g |
| Colistinc or | 2 g (= 60 million U) | 4 g (= 120 million U) | |
| Fosfomycin sodiumb or | 2 g | 2-4 g | |
| Meropenem or | 2 g | 3 gd | |
| Ciprofloxacin | 2 g | 3 g | |
| Yeasts (Candida spp.) or molds (e.g., Aspergillus spp.) | Gentamicin + | 0.5 g | 0.5–1 g |
| Liposomal amphotericin B (Ambisome®) or | 0.2 ge | 0.2 ga, e | |
| Voriconazole | 0.2 g | 0.4 ga | |
aThese Atb concentrations do not fulfill the mechanical ISO requirements for fixation cement
bFosfomycin sodium is preferred over fosfomycin calcium due to better mechanical properties of PMMA
cAvailable as colistin sodium or colistin sulfate (equal efficacy)
dImproved efficacy and antimicrobial release in combination with gentamicin 1 g and clindamycin 1 g
eThe literature is still controversial regarding minimal effective concentrations