Short-course versus long-course antibiotics in prosthetic joint infections: A systematic review and meta-analysis of one randomized controlled trial plus nine observational studies
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
74
Journal Issue
9
Pages
2507
Date Issued
2019-09-01
Author(s)
Yen, Hung Teng
Hsieh, Ronan W.
Huang, Chung Yen
Hsu, Tzu Chun
Yeh, Timothy
Abstract
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. 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.
SDGs
Publisher
OXFORD UNIV PRESS
Type
journal article