Prescribing antibiotics after joint surgery to prevent infection is common, although there is little evidence to support it, argues a commentary published in CMAJ (Canadian Medical Association Journal)
Infection of a hip or knee joint after surgery can be serious, leading to additional surgery and potential complications. Antibiotics are prescribed before and after surgery to minimize the risk of infection, although there is little evidence indicating that antibiotics given after surgery have benefit.
The commentary authors point to research that shows that bone cement impregnated with antibiotics may be the most effective practice, although its use is not widespread in North America.
"It is interesting that postoperative prophylaxis is sanctioned without supporting evidence, yet the use of antibiotic-impregnated bone cement is not sanctioned despite modest supporting evidence," write Drs. Andrew Morris, Mount Sinai Hospital and University Health Network, and Jeffrey Gollish, Sunnybrook Health Sciences Centre, Toronto, Ontario. "Now that we are in an era of enlightened 'antimicrobial stewardship,' it is fairly safe to say that prescribing additional antimicrobials -- especially if the benefit is questionable -- is never a safe option."
The authors call for large randomized controlled trials to provide good quality evidence to show benefit or lack of benefit of the practice.
CMAJ Open research article: Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials
Patrick Thornley BHSc, Nathan Evaniew MD, Michael Riediger MD, Mitchell Winemaker MD, Mohit Bhandari MD PhD, Michelle Ghert MD