The Role of Oral Antibiotic Treatment in Prosthetic Joint Infections in the Elderly

Abstract

Background: There are over one million patients with a prosthetic joint replacement in the United States. Majority of patients who receive joint arthroplasties are over 65 years of age. Objectives: There are no studies evaluating the best options for antibiotic management in prosthetic joint infection. It is important to evaluate alternative treatment modalities for this age group. Methods: This is a retrospective study evaluating studies published between the years 2000 - 2019. Patients over the age of sixty-five with total joint replacement who had confirmed prosthetic joint infection and received treatment with oral antimicrobial treatment were included in the study. Results: A total of 409 patients were included in this study. 306 patients were successfully treated, whereas treatment failure was noted in 103 patients. Adverse events were only noted on 3 out of 7 studies. Of the events noted, renal failure was the most common and diarrhea was the second most common. Conclusions: Due to the lack of data available, there is a need for prospective study that evaluates the response of oral antimicrobial therapy in the elderly. At this time there is very little data to recommend oral antimicrobial therapy in the literature to make definitive recommendations. However, in the author’s experience, there may be a role for oral antimicrobial therapy in patients who have undergone single stage revision with no significant co-morbidities with a non-multidrug resistant pathogen.