Amikacin-, vancomycin- or amikacin/clindamycin-impregnated gel was placed subcutaneously on either side of horses' necks a total of 6 times each. Interstitial fluid was collected at 0, 4, 8, 12 and 24 hours, and days 2 through 10, via capillary ultrafiltration probes placed within the incision (0cm) and 1.5cm laterally. Plasma or serum was collected at days 0, 1 and 7. Biopsy samples were obtained at the completion of the study. A histomorphologic score was assigned to each sample, and the differences in mean scores between treatment (gel) and control incisions were assessed using Wilcoxon signed rank test. Amikacin and vancomycin samples were analyzed via fluorescence polarization immunoassay; clindamycin samples were analyzed via high performance liquid chromatography. Concentrations greater than 2000 times the MIC of vancomycin and clindamycin, greater than 1000 times the MIC of amikacin, and greater than 800 times the MIC of amikacin (amikacin/clindamycin gel) were obtained at 0cm. Mean concentrations remained above MIC for vancomycin and clindamycin for 10 days (0cm) and 8 days (1.5cm); for 9 days (0cm) and 7 days (1.5cm) for amikacin gel; and for 9 days (0cm) and 5 days (1.5cm) for amikacin (amikacin/clindamycin gel). Mean plasma amikacin and vancomycin concentrations were negligible; serum clindamycin concentrations were greater than MIC (0.52µg/ml and 0.63µg/ml) at 24 hours and 7 days respectively. There were no significant differences in histomorphologic scores between treatment and control incisions. Cross-linked dextran gel is a safe, effective alternative for local antibiotic delivery in horses, with substantially high local concentrations and minimal systemic absorption for amikacin- and vancomycin-impregnated gels. / Master of Science

Le traitement antibiotique local de l'infection osseuse par le polyméthacrylate de méthyle (PMMA), chargé de gentamicine ou de tobramycine, montre actuellement des limites. Ses inconvénients sont liés à la non résorbabilité du PMMA et à la rétention d'une grande partie de l'antibiotique intégré au PMMA. L’association fréquente à l’infection de pertes de substance osseuse a favorisé la recherche de vecteurs d’antibiothérapie locale, alternative au PMMA, parmi les substituts de comblement osseux résorbables et ostéoconducteurs. Les ciments phosphocalciques (CPC) pourraient devenir parmi les plus performants dans cette utilisation. Ils sont biocompatibles et offrent avec le Dicalcium Phosphate-ß-Tricalcium Phosphate (DCPD-ß-TCP), un CPC, la possibilité d'obtention d'un mélange DCPD-ß-TCP-gentamicine à une température de 43°C n'altérant pas l'antibiotique, contrairement aux céramiques phosphocalciques qui sont fabriquées par frittage à très haute température. Le but de notre travail était de tester in vitro (élution d’antibiotique) et in vivo (essai de traitement d'ostéite expérimentale) le DCPD-ß-TCP-gentamicine comme alternative possible au PMMA-gentamicine. [...] / Local antibiotic treatment of osteomyelitis is based on the use of gentamicin- (or tobramycin-) loaded polymethylmethacrylate (PMMA). These two aminoglycosides are effective against most cultured orthopedic microorganisms, including Staphylococcus aureus, the most frequent cause of infection. The extensive use of PMMA as a Local Antibiotic Delivery System (LADS) has various disadvantages. Firstly, only a small proportion (about 5 to 17%) of the antibiotic is released by the cement (trapping effect). Secondly, the most significant problem is that PMMA is not resorbable and presents a physical obstacle to osteogenesis. A second surgical operation is therefore always required to remove the PMMA and to fill the cavity caused by bone loss with a bone graft or a synthetic substitute. Several absorbable synthetic substitutes, such as calcium phosphate ceramics, calcium sulfate, and polymers of polylactic-polyglycolic acids, have been investigated as antibiotic carriers. These synthetic substitutes are largely underused as LADS in clinical practice. Polymers are not perfectly biocompatible, and ceramics provide a burst release of antibiotics as a consequence of their manufacturing techniques (Antibiotic adsorption onto the carrier, after sintering of the carrier at high temperature, 1000-1200°C). We have developed a possible alternative to gentamicin loaded-PMMA for local treatment of osteomyelitis in the form of novel calcium phosphate cement (CPC): dicalcium phosphate dihydrate-β-tricalcium phosphate (DCPD-β-TCP). The biocompatibility of such a cement has been demonstrated experimentally and has been clinically confirmed for the treatment of burst fractures and for filling bone cavities in osteoporotic fractures. DCPD-ß-TCP is made in granules from 2 to 3 mm in diameter to avoid the superficial ―creeping substitution‖ observed when DCPD-β-TCP is used as a cement block. [...]

Background: Pericoronitis is an oral condition characterized by inflammation caused by infection in the gingiva surrounding a partially erupted tooth. Terracortril® with Polymyxin B is an ointment with hydrocortisone, oxytetracycline and Polymyxin B that has been observed to occur in treatment of pericoronitis in general dental care, despite recommendations against local antibiotic treatment in dental care. Aim: The aim was to explore to what extent Terracortril® with Polymyxin B is used in the treatment of pericoronitis in general dental care, and to ascertain if the general dentist’s professional experience and degree of difficulty of the pericoronitis affects the choice of treatment. Methods: A survey was sent to general dentists in the Region Västerbotten, consisting of three patient cases with different severity of pericoronitis asking for acute stage treatment. Background questions about Terracortril® with Polymyxin B were included and working years were inquired for.   Results: 81.4% used Terracortril® with Polymyxin B. Usage was associated with professional experience, where dentists with 0-1 and ≥16 working years used Terracortril® with Polymyxin B more frequently than dentists with 2-5 and 6-15 working years.  The severity of symptoms of pericoronitis was decisive for if the dentist used Terracortril® with Polymyxin B, where usage increased with the severity of pericoronitis. Conclusion: Terracortril® with Polymyxin B is frequently used in treatment of pericoronitis. Both the professional experience and the degree of difficulty of the pericoronitis affect the usage. Terracortril® with Polymyxin B should presumably not be used in the treatment of pericoronitis until supporting evidence is available.