COMPARATIVE EVALUATION OF RESULTS AFTER LOCAL ANTIBIOTIC THERAPY WITH GENTAMYCIN IN FORM OF BEADS AND FLEECE

Abstract

For local antibiotic therapy gentamycin is in clinical use since many years, originally in the form of PMMA beads, later also in the form of resorbable collagen fleece. A prospective study comparing the efficacy of both application forms so far is missing.

In a prospective study 108 patients with chronic sclerosing osteomyelitis were treated by a standardised operative debridement protocol. The debrided cavities were filled with 54 patients (group 1) were treated by local antibiotic beads (Septopal) and 54 patients (group 2) by local resorbable antibiotic fleece (Sulmycin). Both groups were comparable concerning age, location, duration of operation, type of osteomyelitis and predisposing factors. The mean follow-up was 6.1 years (range 3.8 – 9.3). Evaluation was done for the re-operation rate, CRP and ESR, white blood cells and local wound healing criteria.

Twenty-six patients (44 per cent) underwent one or more revision operations because of persistent infection.

In group I 67 per cent and in group II 20 per cent (p = 0.0001). No difference was noted for CRP (p = 0.46), ESR (p = 0.09), white blood cells (p = 0.24) and local wound healing criteria (p =0.34).

After local gentamycin fleece application the early re-operation rate is significantly lower compared to gentamycin beads. After a treatment period of 3 month this difference disappears.