Local injection of any medication within the soft tissues has a limited effect as it is absorbed approximately within two hours. It is known that the surgical wound is "contaminated" superficially within hours and this contamination lasts for about 7 days (time that skin is found to seal).

Is it better to use this technique (injection of local antibiotics) or in the cases of arthroplasty surgery to use bone cement that is impregnated with gentamycin and has a slow release effect?  The latter seems to be more logical.

In case of known infection cement but local injection will be very short lived.

In the past the continuing lavage and pump suction draining using vast amount of solution of normal saline containing antibiotics was used for days in cases of deep wound infection, but the use of antibiotics was not proven to be detrimental as nobody knew if healing was achieved due to antibiotic or the continuing flow of normal saline and washing of the wound. One thing was known, that these patients by the end of the treatment were anaemic, due to the continuing dilution and drainage of their blood through the wound. 

Dear George,

Thank you. 

We never use local antibiotics neither in open fractures nor surgical wounds prophylaxis. Just cement and rarely sponge with gentamycin. In open fractures we use two anibiotics intavenously (i.e. cefalosporin + klindamycin) and  lavage with saline (5-10 litres). In elective surgeries just one dose of intravenous antibiotic.

There was an article published in JBJS in November 15  which showed effectiveness of local gentamycin. We do use powdered vancomycin in infected and open but our study is in early stages.

I never used local infiltration of gentamicin. Did you ever experience toxic soft tissue reactions? I am not aware of any guideline advocating this practice. If your infection rate is lower than others a clinical study would be needed. Personally I agree with George and am afraid that it does not bring any benefit but potential harm to soft tissue healing in problematic areas

We do not use local antibiotics for prevention of SSI and I agree with the colleagues above. Recently, I read a RCT on gentamycin-containing collagen sponges in THA. No benefit was found. Perhaps, you may extrapolate to have an answer to your question. S. below: 

Effectiveness of gentamicin-containing collagen sponges for prevention of surgical site infection after hip arthroplasty: a multicenter randomized trial

Clin Infect Dis. 2015 Jun 15;60(12):1752-9

Westberg M. et al.

739 patients with a displaced femoral neck fracture to be treated with hemiarthroplasty were randomized into two groups, which received either routine intravenous antibiotic prophylaxis alone or intravenous antibiotic prophylaxis and local application of 2 gentamicin-containing collagen sponges into the hip joint. The purpose of the study was to determine the efficacy of these sponges in reducing surgical site infections (SSIs) within 30 days of surgery, in addition to routine antibiotic prophylaxis. The results indicated that gentamicin-collagen sponges did not provide any added benefit in terms of SSI incidence.

Level of Evidence: 2  (RCT) , Study Type: Therapy

Dear Rene Attal,

We have an experience of  Local administration of Gentamicin in an Open fracture after debridement and lavage with NS with addtitional IV antibiotics. And we have never experienced toxic soft tissue reactions.

But, I dont have any experience of Local administration of Gentamicin intraoperatively as a prophylactic antibiotics in Surgical wounds.

Thank you.

Thank you everyone for your valuable comments.

I do use collagen with high dose of gentamicin call collatame.  Clinically it seem to be useful and excellent in the case of high incident of infection like open fracture. Diabetic patient. I did not do the study but clinically. I am happy with the result.

No experience on local gentamicin injection

Since the 60-ties gentamicin was used by Prof.H.W.Buchholz in Endo-Klinik Hamburg as prophylaxis in Palacos for aerthoplasties. He further developped techniques for mixing a variety of antibioticis (after resistance-testing) together with Prof. Lodenkaemper. The elution-process works in Palacos longer than 10 yrs. even!!!

Even if it seems effective, it will be hard to determine whether the effect was due to local administration or routine IV antibiotic prophylaxis shot given preoperatively.

Thank You Ganesh .

Is there any studies regarding the use of local antibiotics?

lokal antibiotics were a large topic in the past. If routinely applied there are a significant rise in local allergic reactions. If you would think about MRSA by giving antibiotics (broad spectrum)? Be careful- AB should be given if necessary and best after identification of the germs resistance and sensitivity.

Dear Jean,

Do you prefer using Prophylactic IV AB in all of yours routine cases or only if necessary???

Thank you.

For me. I always use prophylactic iv antibiotic

Local antibiotic injections (including Gentamicin) have extremely questionable value. IV antibiotics remain the gold standard.

Details can be accessed at one of the recent review articles:

http://www.ncbi.nlm.nih.gov/pubmed/26910558

Not me. Vancomycine mixed with the bone graft, has been shown to work, especially if MRSA is endemic.

Thank you all.

Sometime back, gentamicin beads were available for implant. 

Dear Venkatesh,

Do you still use Gentamicin beads?

What was your experience in the past ?

Thank you.

dont use genta beads as prophylaxis! Use them only after a pisitive resistence!

We haven't done it in the pediatric patients. 

Regarding prophylactic antibiotic usage the guideline are pretty clear and I don't see any role of Local antibiotic infiltration for prophylaxis.

Thank you everyone.

Local ge4namycin in beads is a useful adjunct to systemic antibiotic in immuno compromised patient ,in revision surgery and in long term surgery taken more than 3 hrs, provided the patients renal system permits

Dear Amal,

Thank You.

Thank you asok for reading my comment

Dear Sir,

You are welcome.

Patients with open wound, in revision hips surgery and in Chronic Osteomyelitis, most often we don't get a positive isolation of causative organism. Hence either Gentimycin or Vancomycin beads are used while closing the wound.  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740612/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740612/