Short-Course Antibiotics Comparable to Longer Therapy After Orthopedic Surgery, finds study

A new study published in The New England Journal of Medicine showed that in patients having orthopedic surgery and receiving local antibiotics, a brief period of systemic antibiotics was equally effective as a longer duration in preventing definite treatment failure after 12 months.

Although extended treatment plans have been common in treating orthopedic infections, new findings propose that briefer courses could be just as effective for certain patients. Deciding on the best duration for treatment continues to be a significant clinical concern. Hence, this research investigated whether using local antibiotics administered by a device placed at the site of infection during surgery could decrease the need for extended systemic antibiotic therapy.

In a study conducted across multiple centers, without blinding, to compare the efficacy of different durations of postoperative systemic antibiotic therapy in adults who had orthopedic infection surgery and a local-antibiotic carrier implanted, participants were randomly assigned in a 1:1 ratio to receive either long-term (≥4 weeks) or short-term (≤7 days) antibiotic treatment. The main goal was to determine if there was a significant difference in treatment failure within 12 months, as evaluated by a committee following specific criteria, without knowing which treatment group the participants belonged to. A margin of 10 percentage points was set to establish noninferiority.

A total of 500 patients were randomly assigned, with 475 patients evaluated in the main analysis. In the long-duration group, 34 out of 241 patients (14.1%) experienced definite treatment failure, while in the short-duration group, 26 out of 234 patients (11.1%) had treatment failure (risk difference favoring short duration, -3.0 percentage points; 95% confidence interval [CI], -9.0 to 3.0), meeting the specified noninferiority margin.

Sensitivity analyses in the total (497 patients) and per-protocol (457 patients) populations yielded results consistent with the main analysis (risk difference, -2.4 percentage points [95% CI, -8.2 to 3.5] and -2.7 percentage points [95% CI, -8.8 to 3.4], respectively). By the sixth week post-surgery, symptoms potentially linked to treatment were reported by 45.2% of patients in the long-duration group and 17.2% in the short-duration group (risk difference, -28.0 percentage points; 95% CI, -36.4 to -19.6).

Overall, in individuals who had orthopedic surgery and were given local antibiotics, a brief period of taking systemic antibiotics was just as effective as a prolonged course in preventing definite treatment failure within 12 months.

Source:

McNally, M., Dudareva, M., Kümin, M., Vach, W., Scarborough, C. L., Cichero, M. J., Sousa, R., Ferguson, J., Stubbs, D. A., Atkins, B. L., Ramsden, A. J., Young, B. C., Carvalho, A. D., Kendal, A. R., Alvand, A., Palmer, A. J. R., Loizou, C. L., Kendrick, B., Taylor, A. H., … Scarborough, M. (2026). Short or long antibiotic regimens in orthopedics. The New England Journal of Medicine, (NEJMoa2506756). https://doi.org/10.1056/NEJMoa2506756