Antibiotic Simplex contains barium sulphate as opacifier which has a lower radiopacity than

zirconium dioxide, which is used in COPAL® G+C. Therefore, Antibiotic Simplex is less visible in
x-rays. Barium sulphate is also known to cause a greater osteolytic response which leads to a
pathologic bone resorption. (Wimhurst et al. Wang et al.)

No colorant is added to Antibiotic Simplex – it is of white colour, as is the bone. COPAL ® G+C
is of green colour due to the chlorophyll in the cement powder and the liquid. Therefore
COPAL® G+C shows a clearer visibility in the operation field.

 Erythromycin is a macrolide antibiotic with an antimicrobial spectrum active against

gram-positive and anaerobes. There is an increasing prevalence of erythromycin
resistances observed (5-20% resistances against streptococcus and pneumococcus;
20-50% of resistant staphylococcus strains) as it is often used to fight pneumonia and
bronchitis and frequently used topical for infected dermatoses such as acne. It is also
very often used off-label in low doses to enhance the gastrointestinal peristalsis, which
might support the development of resistances.

 Colistin is a polypeptide antibiotic from the group of polymyxins active against gram-
negative germs such as Escherichia coli, enterobacteria, salmonella and klebsiella. It
is a last-resort antibiotic and also active against multi-drug resistant pseudomonas,
ESBL-producing germs (Extended Spectrum ß-Lactamases) and carbapenem-
resistant enterobacteria. Colistin was introduced into clinical practice over 50 years
ago but due to high rates of adverse drug reactions such as nephrotoxicity and
neurotoxicity its use was limited the last years. Furthermore, no detailed trials on
pharmacology and pharmacokinetics and therefore standardized dosing of colistin
exists. The optimal dosing for colistin for most infections is unknown. Colistin
resistance increases in Greece among community strains.