Treatment without long courses of systemic antibioticsBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3052 (Published 28 July 2009) Cite this as: BMJ 2009;339:b3052
- David Harvey, SpR microbiology1,
- Rob Townsend, consultant medical microbiologist1,
- Robert Kerry, consultant orthopaedic surgeon1,
- Ian Stockley, consultant orthopaedic surgeon1
We manage prosthetic joint infection without systemic antibiotics or prolonged hospital admission (or intravenous antibiotics via outpatient intravenous services).1 We target antibiotic treatment to organisms isolated from either a diagnostic aspirate or joint washout (in the case of early infection). At the first stage revision, after thorough debridement of all infected material, we then use cement beads loaded with an appropriate antibiotic based on the aspirate results.2 3
Systemic antibiotics are generally not required beyond surgical prophylaxis because high eluted concentrations of antibiotic from the cement beads provide effective local antimicrobial activity with minimal or no systemic absorption. Outcome data using this approach are comparable to those described by Matthews and colleagues.4
Matthews and colleagues state that managing prosthetic joint infection with antibiotic loaded spacers is expensive and time consuming and results in tissue damage. We think that infected prosthetic material requires surgical debridement along with dead tissue and bone, which does indeed take time. However, treating patients at home with antibiotic loaded cement in situ is more cost effective than treating them in hospital with intravenous antibiotics or in an outpatient intravenous service. It also has the benefit of reduced Clostridium difficile infection, line associated bacteraemias, and side effects from long term antibiotics.
Cite this as: BMJ 2009;339:b3052
Competing interests: None declared.