Short Antibiotic Course Matches Longer Regimen After Orthopedic Surgery With Local Implants

A trial found that giving patients no more than a week of systemic antibiotics after surgery for orthopedic infection with local antibiotic implants was as effective as the standard multi-week course. At 12 months, treatment failure occurred in 11.1% of the short-duration group versus 14.1% in the long-duration group, meeting noninferiority criteria. Additionally, fewer patients in the short-duration group reported potential antibiotic-related symptoms at 6 weeks (17.2% vs 45.2%).

The SOLARIO trial enrolled 475 adults undergoing curative surgery for orthopedic infections, all receiving an implanted local antibiotic carrier plus perioperative systemic antibiotics. Patients were randomized to either ≤7 days or ≥4 weeks of postoperative systemic therapy. The 12-month definite treatment failure rates were 11.1% versus 14.1%, respectively, within the prespecified noninferiority margin of 10 percentage points. Notably, potential antibiotic-related symptoms at 6 weeks were far less common in the short-duration group (17.2% vs 45.2%). The authors emphasized that local antibiotic delivery offers high local concentrations with limited systemic absorption, though risks include hypercalcemia, renal impairment, or wound leakage. They cautioned against extrapolating results to unlicensed local delivery methods like antibiotic powder or irrigation devices.