A 60-year-old man on ICU has a periprosthetic joint infection. He is being treated with IV flucloxacillin for MSSA. The orthopaedic team plans a DAIR ...

Question

A 60-year-old man on ICU has a periprosthetic joint infection. He is being treated with IV flucloxacillin for MSSA. The orthopaedic team plans a DAIR (debridement, antibiotics, and implant retention) strategy. After DAIR, what oral antibiotic combination is typically used for prolonged suppressive therapy?

Accepted Answer

Oral rifampicin in combination with a companion antibiotic (e.g. ciprofloxacin, fusidic acid, or co-trimoxazole) - rifampicin has unique anti-biofilm activity that penetrates and disrupts staphylococcal biofilm on prosthetic material, but must NEVER be used as monotherapy due to rapid resistance emergence

Answer

Oral amoxicillin monotherapy

Answer

Oral metronidazole monotherapy

Answer

No oral antibiotics are needed after DAIR

Answer

Oral vancomycin

uk-fficm MCQ (SBA): PJI - DAIR and Rifampicin