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ANTIBIOTIC
TREATMENT
The choice of antibiotic
The selection of the antibiotic for the treatment of the
infection around the total joint depends on the sensitivity of the bacterial strain that
caused the infection.
Unfortunately, often there is more than one bacterial
strain found in the infected joint.
Moreover, in about 10 -20 per cent of all total joint
infections, no bacteria grow in the sample taken from the infected joint, although there
are other obvious signs of infection present.
It is also possible that the bacteria are there, in the
samples taken, but they will not grow because the bacteriologist used inappropriate
technique for bacterial cultivation, or because the surgeon took few samples from the
operation wound.
Consultation with the infectious-disease specialist is then
extremely valuable. He will help to choose the appropriate antibiotic and to monitor the
efficacy and the safety of the established antibiotic therapy.
When the bacteria causing the infection is not known, the
surgeon usually relies on the past experience. The surgeon supposes that the as yet
unknown bacterial strain has the same sensitivity to antibiotics as the majority of
bacterial strains recovered from the postoperative infections in the past; most surgeons
use a cephalosporin antibiotic.
The duration of antibiotic therapy
after revision operation varies widely, depending on the
character of the infection and the surgeon. Most surgeons use six weeks period of
antibiotic treatment after revision operation, and choose the dose of antibiotic that
according to the laboratory tests will kill 99% of infecting bacteria. Short antibiotic
treatment causes a recurrence of the infection.
| DURATION OF ANTIBIOTIC
THERAPY |
PER CENT OF RECURRENCE |
| < 28 days |
43 % |
| > 28 days |
8 % |
Antibiotic suppression
is a term denoting a long term treatment with antibiotics
of patients whose infected prosthesis was not removed.
The long term use of suppressive antibiotics should inhibit
the growth of bacteria around the infected prosthesis. The value of the suppressive
treatment is discussed.
It may be used in patients who may not tolerate a revision
operation for medical reason, for patients who were infected with "kind"
bacteria that were sensitive to several antibiotics, or for patients who refused yet
another surgery. Statistics show that in these patients the infection was suppressed for 4
years in about 60 % of all cases
In many patients, however, the continuous antibiotic
therapy provokes adverse effects, such as an allergy against the antibiotic. Such long
antibiotic therapy also provokes emergence of bacterial strain resistant to antibiotics.
Certain antibiotics may cause a possibly
lethal bowel inflammation (necrotising colitis) with prolonged
administration. The first sign is severe diarrhoea, be observant of it.
References
Garvin KL et al J Bone Joint Surg-Am 1995;
77-A:1576 - 88
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