Hollow mesoporous silica (HMS) have been extensively investigated as a biomaterial for drug delivery. The present study developed quaternary ammonium silane-grafted hollow mesoporous silica (QHMS) to create a metronidazole (MDZ) sustained delivery system, MDZ@QHMS, with bimodal, contact-kill and release-kill capability. The QHMS was assembled through a self-templating method. Metronidazole was incorporated within the QHMS core using solvent evaporation. Antibacterial activities of the MDZ@QHMS were investigated using single-species biofilms of Staphylococcus aureus (ATCC25923), Escherichia coli (ATCC25922) and Porphyromonas gingivalis (ATCC33277). The MDZ@QHMS maintained a hollow mesoporous structure and demonstrated sustained drug release and bacteridal actvity against the three bacterial strains at a concentration of 100 mu g/mL or above. These nanoparticles were not relatively cytotoxic to human gingival fibroblasts when employed below 100 mu g/mL. Compared with HMS, the MDZ@QHMS system at the same concentration demonstrated antibiotic-elution and contact-killing bimodal antibacterial activities. The synthesized drug carrier with sustained, bimodal antibacterial function and minimal cytotoxicity possesses potential for localized antibiotic applications. Statement of Significance The present study develops quaternary ammonium silane-grafted hollow mesoporous silica (QHMS) to create a metronidazole (MDZ) sustained delivery system, MDZ@QHMS, with bimodal, contact-kill and release-kill capability. This system demonstrates sustained drug release and maintained a hollow mesoporous structure. The synthesized drug carrier with sustained, bimodal antibacterial function and excellent biocompatibility possesses potential for localized antibiotic applications. Published by Elsevier Ltd on behalf of Acta Materialia Inc.