Safety and Tolerability of Fluoroquinolones in Patients with Staphylococcal Periprosthetic Joint Infections

Abstract

Background Fluoroquinolones (FQs) are known to be accompanied by significant risks. However, the incidence of adverse events (ADE) resulting in unplanned drug discontinuation when used for periprosthetic joint infections (PJI) is currently unknown. Methods This study included 156 patients over the age of 18 treated for staphylococcal PJI with debridement, antibiotics, and implant retention (DAIR), between January 1, 2007 and November 21, 2019. Of the 156 patients, 64 had total hip arthroplasty (THA) and 92 had total knee arthroplasty (TKA) infections. The primary outcome was rate of unplanned drug discontinuation. Secondary outcomes included incidence of severe ADE, unplanned rifamycin discontinuation, mean time to unplanned regimen discontinuation, and all-cause mortality. Results Overall, unplanned drug discontinuation occurred in 35.6% of patients in the FQ group and 3% of patients in the non-FQ group. The rate of unplanned discontinuation of FQ regimens as compared to non-FQ regimens was 27.5% vs 4.2% (p=0.021) in THA infections and 42% vs 2.4% (p<0.001) in TKA infections. There was no significant difference in severe ADEs between FQ and non-FQ regimens in both THA and TKA infections. The overall rate of non-severe ADEs in FQ compared to non-FQ regimens was 43.3% vs 6.1% (p<0.001). FQs were associated with tendinopathy, myalgia, arthralgia, and nausea. Conclusions A significantly higher rate of unplanned drug discontinuation was associated with FQ as compared to non-FQ regimens. This provides a real-world view of the implications of FQ related adverse events on unplanned discontinuation when used in prolonged durations for the management of staphylococcal PJIs.

Insulinotropic Potential of Moxifloxacin and Gemifloxacin: An In Vivo Rabbits Model Study Followed by Randomized Phase I Clinical Trial

“…Fluoroquinolones (FQs) belong to a class of broad-spectrum antibiotics used to kill various microorganisms [ 1 , 2 ]. During the last two decades, newer fluoroquinolones have been introduced into the market [ 3 ].…”

Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

“…Most international guidelines have adopted rifampicin combination therapy as the cornerstone antibiotic treatment for staphylococcal PJI treated with DAIR, based on experimental animal models, 1 randomized trial, and several cohort studies. However, rifampicin combination therapy is associated with significant side effects and drug-drug interactions, making its use less patient-friendly [ 4 , 5 ]. Moreover, the literature regarding the effect of rifampicin combination therapy against staphylococcal hip and knee PJI after DAIR has not yet been explored systematically.…”

Implementation of a consensus protocol for antibiotic use for bone and joint infection to reduce unnecessary outpatient parenteral antimicrobial therapy: A quality improvement initiative

“…It is possible that ID providers are not comfortable in selecting fluoroquinolone as a drug of choice for S. aureus BJI in the United States. 23 Our 6-month recurrence rates were 21.3% in patients treated with OPAT and 34.2% in patients treated with oral antibiotics. These recurrence rates were higher than those reported in the OVIVA trial, which reported 1-year recurrence rates of 14.6% in OPAT group and 13.2% in the oral antibiotic group.…”