Quinolones News

#12 May 2, 2017

Short duration of levofloxacin plus rifampicin as effective as longer duration in patients with acute staphylococcal prosthetic joint infections

Prosthetic joint replacement is an extremely successful treatment for patients with reduced mobility and arthritic pain. However in some cases infection is a serious complication requiring debridement, antibiotics and implant retention (DAIR). In regard to medical management, levofloxacin plus rifampicin (L+R) is recommended as first-line treatment for acute staphylococcal prosthetic joint infection (PJI) for a period between 3 months (hip) to 6 months (knee). Empiric management has traditionally used long duration regimens, but these are associated with increased rate of adverse events and selection of resistant bacteria. Some studies suggest that shorter treatments could be as effective and to investigate this researchers carried out a trial in which patients with an early post-surgical or haematogenous staphylococcal PJI and retained implant were treated with either levofloxacin (750mg once daily) plus rifampicin (600mg once daily) for 8 weeks (short group) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively).

175 patients were eligible, with 63 enrolled in the final study. Of these, 33 patients were randomized to receive the long schedule and 30 received the short schedule. The patient demographic features were similar for both groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031).

In ITT analysis 58% of patients in the long schedule group were classified as cured, compared to 73% in the short schedule. 44 patients were entered in the per-protocol analysis with a cure rate of 95% for the long and 91.7% for the short treatment group, respectively. The researchers concluded that this trial suggests that 8 weeks of levofloxacin and rifampicin is non-inferior to longer standard treatments for acute staphylococcal PJI. However they noted that while this was true for hip infections, the benefit for knee infections was less clear and more research is needed.

PMID: 27524103

Int J Antimicrob Agents. 2016 Sep;48(3):310-6. doi: 10.1016/j.ijantimicag.2016.05.021.

Source: https://www.ncbi.nlm.nih.go v/pubmed/27524103?dopt=Abstract

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