Journal of Orthopaedic Research Volume 32, Issue S1 p. S152-S157

Oral Antibiotic Therapy

Patrick O'Toole MD
This panel has reviewed the indication and duration of oral antibiotics for periprosthetic joint infection (PJI) in the following situations:
  1. Acute (early or late) PJI treated with debridement without implant removal and exchange of the modular components, whenever modular components can be safely removed. In general, these infections do not require suppressive antibiotic therapy (SAT).
  2. Indications for the use of SAT include:
    1. Patients who refuse surgical treatment.
    2. Patients who cannot be surgically treated because of a high surgical risk due to comorbidities.
    3. Patients treated with inadequate surgery such as: (1) debridement without implant removal in late chronic PJI or (2) debridement without implant removal in acute (early or late) PJI but without exchanging the modular components.
    4. Patients who undergo optimal surgical treatment in acute PJI but receive suboptimal antibiotic treatment in the following situations: (1) not receiving rifampin in PJI due to Staphylococcus spp, (2) PJI due to methicillin‐resistant S. aureus (MRSA), (3) not receiving a fluoroquinolone in gram‐negative infections, and (4) fungal infections.
    5. Patients in whom it is suspected that the infection is not eradicated according to clinical, laboratory, or imaging data.

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