Oral tetracyclines for bone and joint infections: what do we know?

Area of Science:

• Infectious Diseases
• Pharmacology
• Orthopedic Surgery

Background:

• Complex bone and joint infections (BJIs), including prosthetic joint infections (PJIs), are challenging, often requiring surgery and long-term antibiotics.
• Staphylococci are the primary pathogens in PJIs, with an incidence of 0.79%–2.4% in knee and hip arthroplasties in France.
• Oral antibiotics may be as effective as intravenous therapy, with 12-week treatment durations suggested.

Purpose of the Study:

• To review the existing literature on the role of oral tetracyclines in managing BJIs.
• To assess the pharmacological properties and clinical efficacy of oral tetracyclines for BJIs.

Main Methods:

• A systematic literature review was conducted using PubMed and ScienceDirect.
• 648 articles were screened, with 31 studies ultimately included in the review.

Main Results:

• Pharmacological data indicate favorable bone penetration (0.06–0.75 ratio) and low resistance (<20%) to oral tetracyclines among BJIs pathogens.
• Four studies showed potential inhibition of bacterial growth, while eight studies (62 patients) reported 82%–100% success rates for curative PJIs treatment.
• Ten studies (201 patients) reported 57%–100% success rates for suppressive therapy, with adverse effects leading to discontinuation in <20% of cases.

Conclusions:

• The current body of evidence supporting oral tetracyclines for BJIs is limited.
• Further robust pharmacological and clinical studies are necessary to establish the safety and efficacy of oral tetracyclines in treating BJIs.