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Systemic exposure to tobramycin after local antibiotic treatment with calcium sulphate as carrier material

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Osteoset® T is a calcium sulphate void filler containing 4% tobramycin sulphate, used to treat bone and soft tissue infections. Despite systemic exposure to the antibiotic, there are no pharmacokinetic studies in humans published so far. Based on the observations made in our patients, a model predicting tobramycin serum levels and evaluating their toxicity potential is presented.

Methods

Following implantation of Osteoset® T, tobramycin serum concentrations were monitored systematically. A pharmacokinetic analysis was performed using a non-linear mixed effects model based on a one compartment model with first-degree absorption.

Results

Data from 12 patients treated between October 2006 and March 2008 were analysed. Concentration profiles were consistent with the first-order slow release and single-compartment kinetics, whilst showing important variability. Predicted tobramycin serum concentrations depended clearly on both implanted drug amount and renal function.

Discussion and conclusion

Despite the popularity of aminoglycosides for local antibiotic therapy, pharmacokinetic data for this indication are scarce, and not available for calcium sulphate as carrier material. Systemic exposure to tobramycin after implantation of Osteoset® T appears reassuring regarding toxicity potential, except in case of markedly impaired renal function. We recommend in adapting the dosage to the estimated creatinine clearance rather than solely to the patient’s weight.

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Acknowledgments

The authors received no external funding for this work.

Conflict of interest

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Authors and Affiliations

  1. Department for Orthopaedic Surgery, Cantonal Hospital, 1708, Fribourg, Switzerland

    Peter Wahl, Matthias Jacobi & Emanuel Gautier

  2. Department for Clinical Pharmacology, CHUV, 1011, Lausanne, Switzerland

    Françoise Livio & Thierry Buclin

Authors
  1. Peter Wahl
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  2. Françoise Livio
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  3. Matthias Jacobi
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  4. Emanuel Gautier
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  5. Thierry Buclin
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Correspondence to Peter Wahl.

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Wahl, P., Livio, F., Jacobi, M. et al. Systemic exposure to tobramycin after local antibiotic treatment with calcium sulphate as carrier material. Arch Orthop Trauma Surg 131, 657–662 (2011). https://doi.org/10.1007/s00402-010-1192-2

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  • DOI: https://doi.org/10.1007/s00402-010-1192-2

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