Optimizing Antibiotic Therapy in Musculoskeletal Infections

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.