gms | German Medical Science

Objectives: Suppressive Antibiotic Therapy (SAT) represents a reasonable treatment option for patients with chronic prosthetic joint infection (PJI) when alternative strategies for infection eradication are no longer feasible. Although SAT has demonstrated efficacy, it is known that prolonged antibiotic therapy is associated with numerous adverse events (AE) that can significantly impact patients’ quality of life.

Our aim was to investigate the occurrence of AEs among patients undergoing SAT, considering the differences in pathogen types and antibiotic regimens compared to those patients only undergoing Single-Stage Exchange (SSE), Two-Stage Exchange (TSE), or Debridement, Antibiotics, and Implant Retention (DAIR) procedures.

Methods: We conducted a prospective study involving patients diagnosed with PJI of the hip or knee who underwent SAT between 2020 and 2022. The primary outcome of interest was the detection of AEs, while secondary outcomes included subjective assessments of SAT tolerability and an exploration of whether higher BMI or specific pathogens were associated with increased AE incidence.

Results: A total of 113 AEs were identified in 23 patients. The most frequently prescribed antibiotic was Amoxicillin (n=11, 47%). Gastrointestinal complaints were the most commonly reported AEs (41%), followed by skin-related AEs (24%) Severe side effects necessitating therapy discontinuation were observed in only one patient. There were no statistically significant disparities observed among the groups concerning the occurrence of AEs. However, patients with a body mass index (BMI) exceeding 25 exhibited a tendency toward experiencing a higher frequency of AEs throughout the treatment regimen, in contrast to those with a BMI below 25 (66% versus 34%; p=0.100).

Conclusion: Suppressive antibiotic therapy in patients with PJI is associated with a range of AEs that may affect therapy adherence and patient quality of life. Careful monitoring of patients and individual benefit-risk assessment are therefore necessary when deciding to continue this therapy. Further studies are needed to better understand the risk profile of SAT in this patient population and to develop appropriate strategies for minimizing AEs.