Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-02-05T03:42:58.821Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of tobramycin-impregnated antibiotic beads in frontal sinus osteomyelitis

Published online by Cambridge University Press:  04 January 2023

E Richards Open the ORCID record for E Richards [Opens in a new window] ,
N Qamar ,
P Naik  and
S Ahmed
E Richards*
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
N Qamar
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
P Naik
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
S Ahmed
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
*
Corresponding author: Dr E Richards, ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2PR, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Osteomyelitis of the frontal bone is a rare but devastating complication of frontal sinusitis. Treatment involves aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. However, systemic antibiotics may struggle to penetrate any remaining infection in devascularised areas, and the morbidity associated with surgical resection of some areas of the skull base is too high. In contrast, locally implanted antibiotics provide a reliable, high concentration of treatment to these areas while also minimising potential systemic side effects. The clinical application of tobramycin beads has primarily been used in orthopaedics as an adjunct to the treatment of tibial osteomyelitis or prosthetic joint infection.

Case report

To the best of the authors' knowledge, the two cases discussed here represent the first use of tobramycin antibiotic beads in frontal sinus osteomyelitis secondary to chronic rhinosinusitis.

Conclusion

These cases show promising use of tobramycin beads in recalcitrant frontal osteomyelitis.

Keywords

OsteomyelitisFrontal SinusTobramycinAnti-Bacterial Agents
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 8 , August 2023 , pp. 934 - 937
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr E Richards takes responsibility for the integrity of the content of the paper

References

Lew, DP, Waldvogel, FA. Osteomyelitis. N Engl J Med 1997;336:999–1007CrossRefGoogle ScholarPubMed
Hatzenbuehler, J, Pulling, TJ. Diagnosis and management of osteomyelitis. Am Fam Physician 2011;84:1027–33Google ScholarPubMed
Tice, AD, Hoaglund, PA, Shoultz, DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med 2003;114:723–8CrossRefGoogle ScholarPubMed
Ostermann, PA, Seligson, D, Henry, SL. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br 1995;77:93–97CrossRefGoogle ScholarPubMed
Prasad, KC, Prasad, SC, Mouli, N, Agarwal, S. Osteomyelitis in the head and neck. Acta Otolaryngol 2007;127:194–205CrossRefGoogle ScholarPubMed
Pincus, DJ, Armstrong, MB, Thaller, SR. Osteomyelitis of the craniofacial skeleton. Semin Plast Surg 2009;23:73–9CrossRefGoogle ScholarPubMed
Thompson, HM, Tilak, AM, Miller, PL, Grayson, JW, Cho, DY, Woodworth, BA. Treatment of frontal sinus osteomyelitis in the age of endoscopy. Am J Rhinol Allergy 2021;35:368–74CrossRefGoogle ScholarPubMed
Masters, EA, Trombetta, RP, de Mesy Bentley, KL, Boyce, BF, Gill, AL, Gill, SR et al. Evolving concepts in bone infection: redefining “biofilm”, “acute vs. chronic osteomyelitis”, “the immune proteome” and “local antibiotic therapy”. Bone Res 2019;7:20CrossRefGoogle Scholar
Varvares, MA, Lin, D, Hadlock, T, Azzizadeh, B, Gliklich, R, Rounds, M et al. Success of multiple, sequential, free tissue transfers to the head and neck. Laryngoscope 2005;115:101–4CrossRefGoogle Scholar
DeCoster, TA, Bozorgnia, S. Antibiotic Beads. J Am Acad Orthop Surg 2008;16:674–8CrossRefGoogle ScholarPubMed
Nelson, CL. The current status of material used for depot delivery of drugs. Clin Orthop Relat Res 2004;427:72–8CrossRefGoogle Scholar
Hoff, SF, Fitzgerald, RH Jr, Kelly, PJ. The depot administration of penicillin G and gentamicin in acrylic bone cement. J Bone Joint Surg Am 1981;63:798–804CrossRefGoogle ScholarPubMed
Wahlig, H, Dingeldein, E, Bergmann, R, Reuss, K. The release of gentamicin from polymethylmethacrylate beads: An experimental and pharmacokinetic study. Bone Joint J 1978;60:270–5Google ScholarPubMed
Fernando, N, Werner, S, Elhaddad, M, Davies, J, Firoozabadi, R. Do antibiotic beads need to be removed? Arch Bone Jt Surg 2020;8:502–5Google ScholarPubMed
Villanueva, K, Martin, D, Martinkovich, S, Blomain, EW. Treatment of a chronically infected nasal silicone prosthesis with continuous antibiotic irrigation and gentamicin-impregnated polymethylmethacrylate beads. JPRAS Open 2017;15:18–24CrossRefGoogle ScholarPubMed
Dagum, AB, Park, DJ, Lau, KN, Khan, SU. Antibiotic-impregnated polymethylmethacrylate beads and cement in the treatment of posttraumatic infections of the frontal sinus. Plast Reconstr Surg 2009;123:193–4CrossRefGoogle ScholarPubMed
Gogia, JS, Meehan, JP, Di Cesare, PE, Jamali, AA. Local antibiotic therapy in osteomyelitis. Semin Plast Surg 2009;23:100–7CrossRefGoogle ScholarPubMed
Eckman, JB Jr, Henry, SL, Mangino, PD, Seligson, D. Wound and serum levels of tobramycin with the prophylactic use of tobramycin-impregnated polymethylmethacrylate beads in compound fractures. Clin Orthop Relat Res 1988;237:213–5CrossRefGoogle Scholar