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Updated: May 13, 2025

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Optimizing Antibiotic Therapy in Musculoskeletal Infections.

Nicolás W Cortés-Penfield1, Julie Ann Justo2, Erin K McCreary3

  • 1Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.

Infectious Disease Clinics of North America
|April 12, 2025
PubMed
Summary

Optimal antibiotic strategies for musculoskeletal infections have evolved, emphasizing oral antibiotics, tailored therapy durations, and selective antimicrobial approaches for better patient outcomes.

Keywords:
Antimicrobial stewardshipBone and joint infectionDiabetes-related foot infectionOral antibioticsOsteomyelitisPeriprosthetic joint infectionProsthetic joint infectionSeptic arthritis

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Musculoskeletal infections require careful antibiotic management.
  • Over 25 years of research, including RCTs and observational studies, have informed current practices.
  • Modern approaches focus on evidence-based decision-making and stewardship.

Purpose of the Study:

  • To review the evidence supporting contemporary antibiotic strategies for orthopedic infections.
  • To discuss advances in antibiotic selection, duration, and prophylaxis.
  • To guide optimal antibiotic stewardship in managing these complex infections.

Main Methods:

  • Systematic review of randomized controlled trials and observational studies.
  • Analysis of evidence for modern antibiotic decision-making principles.
  • Examination of specific practice advances in orthopedic infection management.

Main Results:

  • Increased and earlier use of oral antibiotics is supported by evidence.
  • Principles like "bone penetration" and local antimicrobial strategies are crucial.
  • Individualized therapy durations and selective empiric/prophylactic regimens are key.

Conclusions:

  • Modern antibiotic management of musculoskeletal infections relies on a strong evidence base.
  • Key advances include oral antibiotic use, tailored durations, and selective prophylaxis.
  • Continued stewardship and evidence-based practices are essential for optimal outcomes.