Use of Intrawound Antibiotics in Orthopaedic Surgery.

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Abstract

[Indexed for MEDLINE] 16. Bone Joint J. 2023 Aug 1;105-B(8):850-856. doi: 10.1302/0301-620X.105B8.BJJ-2022-1418.R1. Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology. Azamgarhi T(1), Warren S(2), Fouch S(3), Standing JF(4), Gerrand C(5). Author information: (1)Pharmacy Department, Royal National Orthopaedic Hospital NHS Trust, London, UK. (2)Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK. (3)School of Pharmacy and Biomedical Sciences, Portsmouth, UK. (4)Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK. (5)Division of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust Sarcoma Unit, London, UK. The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic prophylaxis from 24 hours to five days after endoprosthetic reconstruction for lower limb bone tumours. PARITY is the first randomized controlled trial in orthopaedic oncology and is a huge step forward in understanding antibiotic prophylaxis. However, significant gaps remain, including questions around antibiotic choice, particularly in the UK, where cephalosporins are avoided due to concerns of Clostridioides difficile infection. We present a review of the evidence for antibiotic choice, dosing, and timing, and a brief description of PARITY, its implication for practice, and the remaining gaps in our understanding. © 2023 The British Editorial Society of Bone & Joint Surgery. DOI: 10.1302/0301-620X.105B8.BJJ-2022-1418.R1