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Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy
Background: There are currently no recommendations to direct the optimal diagnosis and treatment of fungal osteoarticular infections, including prosthetic joint infections and osteomyelitis. Active agents (fluconazole; amphotericin B) are regularly applied per os or intravenously. Other drugs such a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215076/ https://www.ncbi.nlm.nih.gov/pubmed/37237751 http://dx.doi.org/10.3390/antibiotics12050848 |
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author | Krampitz, Barbara Steiner, Julia Trampuz, Andrej Kühn, Klaus-Dieter |
author_facet | Krampitz, Barbara Steiner, Julia Trampuz, Andrej Kühn, Klaus-Dieter |
author_sort | Krampitz, Barbara |
collection | PubMed |
description | Background: There are currently no recommendations to direct the optimal diagnosis and treatment of fungal osteoarticular infections, including prosthetic joint infections and osteomyelitis. Active agents (fluconazole; amphotericin B) are regularly applied per os or intravenously. Other drugs such as voriconazole are used less frequently, especially locally. Voriconazole is less toxic and has promising results. Local antifungal medication during primary surgical treatment has been investigated by implanting an impregnated PMMA cement spacer using intra-articular powder or by daily intra-articular lavage. The admixed dosages are rarely based on characteristic values and microbiological and mechanical data. The purpose of this in vitro study is to investigate the mechanical stability and efficacy of antifungal-admixed PMMA with admixed voriconazole at low and high concentrations. Methods: Mechanical properties (ISO 5833 and DIN 53435) as well as efficacy with inhibition zone tests with two Candida spp. were investigated. We tested three separate cement bodies at each measuring time (n = 3) Results: Mixing high dosages of voriconazole causes white specks on inhomogeneous cement surfaces. ISO compression, ISO bending, and DIN impact were significantly reduced, and ISO bending modulus increased. There was a high efficacy against C. albicans with low and high voriconazole concentrations. Against C. glabrata, a high concentration of voriconazole was significantly more efficient than a dose at a low concentration. Conclusions: Mixing voriconazole powder with PMMA (Polymethylmethacrylate) powder homogeneously is not easy because of the high amount of dry voriconazole in the powder formulation. Adding voriconazole (a powder for infusion solutions) has a high impact on its mechanical properties. Efficacy is already good at low concentrations. |
format | Online Article Text |
id | pubmed-10215076 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102150762023-05-27 Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy Krampitz, Barbara Steiner, Julia Trampuz, Andrej Kühn, Klaus-Dieter Antibiotics (Basel) Article Background: There are currently no recommendations to direct the optimal diagnosis and treatment of fungal osteoarticular infections, including prosthetic joint infections and osteomyelitis. Active agents (fluconazole; amphotericin B) are regularly applied per os or intravenously. Other drugs such as voriconazole are used less frequently, especially locally. Voriconazole is less toxic and has promising results. Local antifungal medication during primary surgical treatment has been investigated by implanting an impregnated PMMA cement spacer using intra-articular powder or by daily intra-articular lavage. The admixed dosages are rarely based on characteristic values and microbiological and mechanical data. The purpose of this in vitro study is to investigate the mechanical stability and efficacy of antifungal-admixed PMMA with admixed voriconazole at low and high concentrations. Methods: Mechanical properties (ISO 5833 and DIN 53435) as well as efficacy with inhibition zone tests with two Candida spp. were investigated. We tested three separate cement bodies at each measuring time (n = 3) Results: Mixing high dosages of voriconazole causes white specks on inhomogeneous cement surfaces. ISO compression, ISO bending, and DIN impact were significantly reduced, and ISO bending modulus increased. There was a high efficacy against C. albicans with low and high voriconazole concentrations. Against C. glabrata, a high concentration of voriconazole was significantly more efficient than a dose at a low concentration. Conclusions: Mixing voriconazole powder with PMMA (Polymethylmethacrylate) powder homogeneously is not easy because of the high amount of dry voriconazole in the powder formulation. Adding voriconazole (a powder for infusion solutions) has a high impact on its mechanical properties. Efficacy is already good at low concentrations. MDPI 2023-05-04 /pmc/articles/PMC10215076/ /pubmed/37237751 http://dx.doi.org/10.3390/antibiotics12050848 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Krampitz, Barbara Steiner, Julia Trampuz, Andrej Kühn, Klaus-Dieter Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title | Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title_full | Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title_fullStr | Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title_full_unstemmed | Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title_short | Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy |
title_sort | voriconazole admixed with pmma—impact on mechanical properties and efficacy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215076/ https://www.ncbi.nlm.nih.gov/pubmed/37237751 http://dx.doi.org/10.3390/antibiotics12050848 |
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