ÎÎIndefinite chronic oral antimicrobial suppression with either
cephalexin, dicloxacillin, co-trimoxazole, minocycline or doxycycline
may follow the above regimen, based on in vitro susceptibility,
allergies or intolerances (Table 3) (B-III).
ÎÎRifampin alone is NOT recommended for chronic suppression, and
rifampin combination therapy is also not generally recommended.
ÎÎClinical and laboratory monitoring for efficacy and toxicity is
advisable.
ÎÎThe decision to offer chronic suppressive therapy must take into
account the individual circumstances of the patient including:
• the ability to use rifampin in the initial phase of treatment
• the potential for progressive implant loosening and loss of bone stock
• the hazards of prolonged antibiotic therapy.
It is therefore generally reserved for patients who are unsuitable for, or refuse, further
exchange revision, excision arthroplasty, or amputation.
PJI DUE TO OTHER ORGANISMS
ÎÎTreat with 4-6 weeks of pathogen-specific intravenous or highly
bioavailable oral antimicrobial therapy (Table 2) (A-II).
ÎÎFollow published guidelines for monitoring outpatient IV antimicrobial
therapy [Tice AD. op. cit.] (A-II).
ÎÎIndefinite chronic oral antimicrobial suppression should follow
regimens in Table 3 and be based on in vitro sensitivities, allergies
and intolerances (B-III).
▶▶ Chronic suppression after fluoroquinolone treatment of gram-negative bacilli was
not unanimously recommended.
▶▶ Clinical and laboratory monitoring for efficacy and toxicity is advisable.
▶▶ Similar considerations regarding hazards and effectiveness apply to the above.
After Amputation
ÎÎGive pathogen-specific antimicrobial therapy until 24-48 hours after
amputation, assuming all infected bone and soft tissue has been
surgically removed and there is no concomitant sepsis syndrome or
bacteremia.
If sepsis syndrome or bacteremia is present, treat according to recommendations for
these syndromes (C-III).
ÎÎGive 4-6 weeks of pathogen specific intravenous or highly bioavailable
oral antimicrobial therapy if, despite surgery, there is residual
infected bone and soft tissue (i.e. hip disarticulation for THA infection
OR long stem TKA prosthesis where the prosthesis extends above the
level of amputation) (Table 2) (C-III).
Follow published guidelines for monitoring outpatient IV antimicrobial therapy [Tice
AD. op. cit.] (A-II).
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