Antibiotic Choice: The Synergistic Effect of Single vs Dual Antibiotics

• Published in: The Journal of arthroplasty Vol. 35; no. 3; pp. S19 - S23
• Main Authors: Mohamed, Nequesha S., Wilkie, Wayne A., Remily, Ethan A., Nace, James, Delanois, Ronald E., Browne, James A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; antibiotic cement; antibiotic elution; antibiotic synergy; Bacteria; Bone Cements; dual antibiotic cement; dual antibiotics; Humans; antibiotic elution; dual antibiotics; antibiotic cement; dual antibiotic cement; antibiotic synergy
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2019.11.002

This review summarizes single vs dual antibiotic cement literature, evaluating for synergistic activity with dual antibiotics. A systematic review was performed for literature regarding dual antibiotics in cement, identifying 13 studies to include for review. Many in vitro studies reported higher elution from cement and/or improved bacteria inhibition with dual antibiotics, typically at higher dosages with a manual mixing technique. Limited clinical data from hip hemiarthroplasties and spacers demonstrated that dual antibiotics were associated with improved infection prevention and higher intra-articular antibiotic concentrations. In addition to broader pathogen coverage, several studies document synergy of elution and increased antibacterial activity when dual antibiotics are added to cement. Limited clinical evidence suggests that dual antibiotic cement may be associated with reduced infection rates.