The length of antibiotic treatment in patients with periprosthetic joint infection : balancing evidence and experience.

Periprosthetic joint infection (PJI) remains a severe complication after arthroplasty, with rates expected to rise given the ageing population and their increasing rates of comorbidity. Management is challenging due to the interplay between surgical strategies, antibiotic treatment, and patient-specific factors. Traditionally, prolonged courses of antibiotics were used; however, extending therapy may not improve outcomes, and raises risks such as toxicity and antimicrobial resistance. Recent evidence suggests that shorter antibiotic regimens and early transition to oral antibiotics can be equally effective in some circumstances. For patients managed with debridement, antibiotics, and implant retention, a six- to eight-week systemic course of antibiotics may be sufficient when combined with thorough debridement and the use of biofilm-active agents. In two-stage revision, the use of antibiotic-loaded cement spacers permits even shorter lengths of antibiotic treatment, while single-stage revisions may also require shorter regimens under favourable conditions. Early transition to oral antibiotics can also be equally effective compared with prolonged intravenous therapy across all surgical procedures with advantages for patients and healthcare systems. Despite these promising findings, the heterogeneity of studies (including variable definitions of infection and outcome, small sample sizes and diverse surgical techniques) limits the generalizability of the results. Further high-quality, standardized research is required to determine the optimal length of antibiotic treatment in different surgical strategies. Meanwhile, a multidisciplinary approach which carefully balances the efficacy of antibiotic treatment with potential risks is essential for improving outcomes in these patients. The aim of this annotation was to review the current literature dealing with the length of antibiotic treatment in the management of PJI, and to consider the avenues that should be investigated in the future.