Antibiotic Treatment of Common Infections

More Evidence to Support Shorter Durations

Benjamin J. Smith; George Heriot; Kirsty Buising


Curr Opin Infect Dis. 2020;33(6):433-440. 

In This Article

Bone and Joint Infection

Treatment of bone and joint infections is often individualized, depending on the pathogen, the chronicity of infection and the presence of any prosthetic material. Although treatment durations may be necessarily long, there is now good evidence that oral therapy is as efficacious as intravenous in most situations.[42] There have been relatively few randomized trials comparing treatment durations for bone and joint infections.

A recent Swiss RCT demonstrated that two weeks of targeted therapy after surgical lavage is noninferior to four weeks for septic arthritis. However this study was comprised predominantly of infections involving the hand and wrist and was underpowered to draw conclusion regarding infections involving larger joints.[43]

A French multicentre RCT investigating the optimal treatment duration for vertebral osteomyelitis demonstrated that six weeks of directed antibiotic therapy is noninferior to a 12-week course as long as any associated collections have been drained.[44] Of note, culture-negative infections were excluded from this study and there were very low rates of methicillin-resistant S. aureus and therefore the results should be interpreted cautiously for these patients.