Shorter Antibiotic Regimen Fails Noninferiority Test Against Prosthetic Joint Infections

By Reuters Staff

May 27, 2021

NEW YORK (Reuters Health) - When it comes to treating prosthetic-joint infections with antibiotics, less isn't more.

A new French study of 410 volunteers found that six weeks of antibiotic therapy produced more unfavorable outcomes than the standard 12 weeks when used in conjunction with conventional surgery.

Results of the open-label DATIPO trial appear in the New England Journal of Medicine.

There are no well-established guidelines for the duration of antibiotic therapy in such patients, but there have been suggestions from several studies that shorter courses might be effective, according to Dr. Louis Bernard of University Hospital Bretonneau, in Tours, and colleagues.

But the rates of persistent infection when the team put the idea to the test were 18.1% in the group on the six-week regimen versus 9.4% in the group that got 12 weeks of antibiotic therapy, a significant difference that did not meet the criteria for non-inferiority.

The infections were in a prosthetic hip or knee. All had been managed with either a one-stage or two-stage implant exchange or debride with implant retention. Antibiotic therapy was initiated as close to the surgical procedure as possible.

Twenty patients died, but no case was judged to be related to the joint infection.

"The results of the post hoc subgroup analyses consistently favored the 12-week group, and we did not find any inconsistency across the subgroups," the researchers said.

SOURCE: The New England Journal of Medicine, online May 26, 2021.