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Lifelong Suppressive Antibiotics Osteomyelitis — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionLifelong Suppressive Antibiotics OsteomyelitisSCE Infectious Diseases

Chronic prosthetic-joint infection cannot be eradicated because surgery is contraindicated. The isolate is susceptible to a well-tolerated oral agent and symptoms recur whenever treatment stops. What is the correct suppressive-therapy principle?

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Correct answer: D — Use indefinite suppressive therapy with toxicity, adherence and breakthrough-infection monitoring while regularly revisiting source-control options with review after review with follow-up

The best answer is “Use indefinite suppressive therapy with toxicity, adherence and breakthrough-infection monitoring while regularly revisiting source-control options with review after review with follow-up”. When cure is not feasible, suppression is an individualised harm-reduction strategy rather than a fixed-duration curative course. “Never use suppression in any bone or joint infection” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Stop when C-reactive protein first normalises” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Set an arbitrary maximum of 6 months despite relapse off therapy” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Stop at 12 months regardless of surgical feasibility” is less appropriate because it conflicts with the clinical discriminator or cited guidance.

Reference: OVIVA trial report: https://www.nejm.org/doi/full/10.1056/NEJMoa1710926