Infectious Disease

6 weeks of antibiotics no better than 12 weeks for prosthetic joint infections

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Bernard does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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The results of a randomized controlled trial showed that a 6-week course of antibiotics for prosthetic joint infections was not inferior to a 12-week course and resulted in a higher percentage of patients with poor outcomes.

“Treatment for prosthetic joints usually consists of a combination of surgery and antimicrobial therapy.” Louis Bernard, MD, PhD, of the Infectious Diseases Division of Bretonneau University Hospital and colleagues wrote in the New England Journal of Medicine. “The appropriate duration of antimicrobial therapy for this indication remains unclear.”

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Six weeks of antibiotic therapy has not been shown to be inferior to 12 week therapy, and it actually resulted in a higher percentage of patients with adverse outcomes.
Source: Adobe Stock.

Bernard and colleagues conducted an open, randomized, controlled, non-inferiority study called DATIPO (Duration of Antibiotic Treatment in Prosthetic Joint Infections) that compared 6 weeks of antibiotic therapy to 12 weeks of antibiotic therapy in patients with microbiologically confirmed prosthetic joint infection using standard surgical procedures.

The primary result was persistent infection within 2 years of completing antibiotic therapy.

The researchers randomly assigned 410 patients to antibiotic therapy for 6 weeks (n = 205) or 12 weeks (n = 205). They excluded 20 patients who died during follow-up and considered six more patients who were lost to follow-up to be permanently infected.

According to the study, persistent infection occurred in 35 of 193 patients (18.1%) in the 6-week group and in 18 of 191 patients (9.4%) in the 12-week group (95% CI, 1st , 8-15.6).

According to Bernard and colleagues, the protocol and sensitivity analyzes also showed no inferiority of the shorter therapy, and there were no differences between groups in the percentage of patients with treatment failure due to reinfection, likely treatment failure, or severe behavioral side effects.

“This study showed that a shorter course of 6 weeks of antibiotic therapy did not meet the criteria for non-inferiority versus a longer course of 12 weeks in the treatment of prosthetic joint infections and inferior in a higher percentage of patients, most of whom were Results had had a debridement with implant retention, ”the authors wrote. “This difference in risk appeared to be less pronounced in patients who had one-step or two-step implant replacement, but this observation has yet to be explored in a specific randomized study.”

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