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

2019 ◽  
Vol 74 (9) ◽  
pp. 2507-2516 ◽  
Author(s):  
Hung-Teng Yen ◽  
Ronan W Hsieh ◽  
Chung-yen Huang ◽  
Tzu-Chun Hsu ◽  
Timothy Yeh ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Short Course ◽  
Prosthetic Joint Infections ◽  
Long Course

Abstract 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.

scholarly journals Rifampin Combination Therapy in Staphylococcal Prosthetic Joint Infections: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Øystein Karlsen ◽  
Pål Borgen ◽  
Bjørn Bragnes ◽  
Wender Figved ◽  
Bjarne Grøgaard ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Combination Therapy ◽  
Methicillin Resistance ◽  
Controlled Trial ◽  
Combination Group ◽  
Randomized Controlled ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Significant Difference

Abstract Background The evidence supporting rifampin combination therapy in prosthetic joint infections (PJI) is limited due to the lack of controlled studies. The aim of this study is to evaluate the effect of adding rifampin to conventional antimicrobial therapy in early staphylococcal PJIs treated with debridement and retention of the implant (DAIR). Methods In this multicentre randomized controlled trial, 99 patients with PJI after hip and knee arthroplasties were enrolled. They were randomly assigned to receive rifampin or not in addition to standard antimicrobial treatment with cloxacillin, or vancomycin in case of methicillin resistance. The primary end point was no signs of infection after 2 years follow-up. Results 48 patients were included in the final analyses. There were no differences in patient characteristics or co-morbidities between the two groups. There was no significant difference in remission rate between the rifampin combination group (17 of 23 (74%)) and the monotherapy group (18 of 25 (72%), relative risk 1,03, 95% confidence interval 0,73 to 1,45, p=0.88). Conclusion Our study has not proven a statistically significant advantage by adding rifampin to the antibiotic treatment in staphylococcal PJIs.

scholarly journals A Systematic Review and Meta-analysis of Antibiotic Treatment Duration for Bacteremia Due to Enterobacteriaceae

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Giannoula S. Tansarli ◽  
Nikolaos Andreatos ◽  
Elina E. Pliakos ◽  
Eleftherios Mylonakis
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Content Type ◽  
Randomized Controlled ◽  
Short Course ◽  
All Cause Mortality ◽  
Retrospective Cohort Studies ◽  
Long Course

ABSTRACT The duration of antibiotic therapy for bacteremia due to Enterobacteriaceae is not well defined. We sought to evaluate the clinical outcomes with shorter- versus longer-course treatment. We performed a systematic search of the PubMed and EMBASE databases through May 2018. Studies presenting comparative outcomes between patients receiving antibiotic treatment for ≤10 days (“short-course”) and those treated for >10 days (“long-course”) were considered eligible. Four retrospective cohort studies and one randomized controlled trial comprising 2,865 patients met the inclusion criteria. The short- and long-course antibiotic treatments did not differ in 30-day all-cause mortality (1,374 patients; risk ratio [RR] = 0.99; 95% confidence interval [CI], 0.69 to 1.43), 90-day all-cause mortality (1,750 patients; RR = 1.16; 95% CI, 0.81 to 1.66), clinical cure (1,080 patients; RR = 1.02; 95% CI, 0.96 to 1.08), or relapse at 90 days (1,750 patients; RR = 1.08; 95% CI, 0.69 to 1.67). In patients with bacteremia due to Enterobacteriaceae, the short- and long-course antibiotic treatments did not differ significantly in terms of clinical outcomes. Further well-designed studies are needed before treatment for 10 days or less is adopted in clinical practice.

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