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Short-course versus long-course antibiotics in prosthetic joint infections: a systematic review and meta-analysis of
Hung-Teng Yen1, Ronan W Hsieh2, Chung-Yen Huang1
1School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Background:
Prosthetic joint infections (PJIs) often require long-course antibiotic therapy. However, recent studies argue against the current practice and raise concerns such as the development of antibiotic resistance, side effects of medications and medical costs.
Objectives:
To review and compare the outcomes of short-course and long-course antibiotics in PJIs.
Methods:
We conducted a systemic review and meta-analysis using a predefined search term in PubMed and EMBASE databases. Studies that met the inclusion criteria from inception to June 2018 were included. The quality of the included studies was assessed.
Results:
A total of 10 articles and 856 patients were analysed, comprising 9 observational studies and 1 randomized controlled trial. Our meta-analysis showed no significant difference between short-course and long-course antibiotics (relative risk = 0.87, 95% CI = 0.62-1.22). Additionally, the older the studied group was, the more short-course antibiotics were favoured.
Conclusions:
When treating PJI patients following debridement, antibiotics and implant retention, an 8 week course of antibiotic therapy for total hip arthroplasty and a 75 day course for total knee arthroplasty may be a safe approach. For two-stage exchange, a shorter duration of antibiotic treatment during implant-free periods is also generally safe with the usage of antibiotic-loaded cement spacers.
Insights
Short-course antibiotics are as effective as long-course therapy for prosthetic joint infections (PJIs). This finding challenges current practices and suggests shorter treatment durations may be safe, reducing antibiotic resistance and costs.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pharmacology
Background:
- Prosthetic joint infections (PJIs) traditionally necessitate prolonged antibiotic treatment.
- Concerns exist regarding long-course antibiotics, including antibiotic resistance, adverse effects, and high medical costs.
Purpose of the Study:
- To systematically review and compare the efficacy of short-course versus long-course antibiotic regimens for treating PJIs.
Main Methods:
- A systematic review and meta-analysis of studies published up to June 2018.
- Searches were conducted in PubMed and EMBASE databases.
- Study quality was assessed, and data from 10 articles (856 patients) were analyzed.
Main Results:
- No significant difference in outcomes was found between short-course and long-course antibiotic treatments for PJIs (RR = 0.87, 95% CI = 0.62-1.22).
- Older patient populations showed a preference for shorter antibiotic courses.
- Included studies comprised 9 observational studies and 1 randomized controlled trial.
Conclusions:
- An 8-week antibiotic course for total hip arthroplasty and a 75-day course for total knee arthroplasty may be safe following debridement, antibiotics, and implant retention.
- Shorter antibiotic durations during the implant-free period of two-stage exchange arthroplasty are generally safe when using antibiotic-loaded cement spacers.
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