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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...

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Autores principales: Krampitz, Barbara, Steiner, Julia, Trampuz, Andrej, Kühn, Klaus-Dieter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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.
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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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AT kuhnklausdieter voriconazoleadmixedwithpmmaimpactonmechanicalpropertiesandefficacy