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Shorter course of antibiotics found noninferior for orthopedic surgery patients
News briefToday at 12:08 p.m.
Chris Dall, MA
Topics
Antimicrobial Stewardship
The results of a multicenter randomized controlled trial indicate that a short course of systemic antibiotics is noninferior to a long course in patients who’ve undergone orthopedic surgery, researchers reported last week in the New England Journal of Medicine.
Conducted at 25 sites in the United Kingdom, Austria, Germany, Portugal, and Spain, the SOLARIO (Short or Long Antibiotic Regimens in Orthopaedics) trial randomly assigned 500 patients who’d undergone surgery for a confirmed orthopedic infection to receive postoperative antibiotic therapy for a short duration (seven days or less) or a long duration (four or more weeks). Local antibiotics were delivered by a device that was implanted during surgery. The primary outcome was definite treatment failure by 12 months, with a noninferiority margin of 10 percentage points.
Postoperative systemic antibiotic treatment for orthopedic infection typically lasts at least four weeks.
“Orthopedic infection is usually managed with surgery and prolonged systemic antibiotic therapy,” a team led by investigators from Oxford University Hospitals wrote. “Whether local antibiotics delivered by a product implanted at the infection site during surgery can reduce the duration of systemic antibiotic therapy is unclear.”
Less treatment failure, fewer side effects
Definite treatment failure occurred in 14.1% of patients in the long-duration group and 11.1% in the short-duration group, for a risk difference of –3.0 percentage points, which met the prespecified noninferiority margin. Results of sensitivity analyses were consistent with the primary analysis.Potential side effects of antibiotic therapy, a secondary outcome, occurred in 45.2% of patients in the long-therapy group and 17.2% of patients in the short-duration group (risk difference, –28.0 percentage points.)
“The anticipated advantages of short-duration therapy, which include fewer symptoms associated with treatment and shorter durations of hospital stay without an increased risk of death or serious adverse events, were seen in the current trial,” the authors wrote.
Quick takes: Pennsylvania asks CDC to recognize measles deaths, Trump's push to split up vaccine doses
News briefToday at 10:24 a.m.
Stephanie Soucheray, MA
Topics
Measles
Childhood Vaccines
- -Pennsylvania Secretary of Health Debra L. Bogen, MD, sent a letter to the Centers for Disease Control and Prevention (CDC) formally requesting the agency recognize the state’s four measles deaths as a condition of receiving emergency assistance (Epi-Aid) from the agency. “The CDC’s choice not to publicly recognize the deaths undermines our response,” Bogen wrote. “For this reason, if CDC is unable to transparently and accurately communicate information about those measles-associated deaths, the Department will respectfully rescind our request for a CDC Epi-Aid.” Pennsylvania Gov. Josh Shapiro first mentioned this request late last week. According to the state’s dashboard, there are now 792 measles cases in Pennsylvania, with 93 new cases reported in the last week. Four people have died, and 150 have been hospitalized.
- In the Oval Office on Friday, President Trump said he would propose breaking up some childhood vaccine doses into five separate shots, reducing the vaccine dose to 20% of a single shot. “We’re going to recommend that they do five doses marked one, two, three, four, five and that they be given in six-month intervals, so that a small amount of the vaccine gets pumped into the body,” Trump said. He did not specify which vaccines he was talking about but suggested the move would result in a “massive reduction in autism.” Vaccine experts were quick to say this plan would render vaccines ineffective. Earlier this year, Trump suggested doctors split the measles, mumps, and rubella vaccine into separate vaccines, another move experts said would result in more vaccine-preventable illnesses.