With moderate level of evidence, 76% of delegates (super majority/strong consensus) of the most recent (2018) International Consensus Meeting on orthopedic
infections agreed that extended oral
antibiotics directed toward initial organisms after
reimplantation for 3 months probably reduce the risk of failure due to periprosthetic joint
infection. Nevertheless, the use of oral
antibiotics becomes increasingly problematic with extended or long-term utilization. The development of antibiotic resistance and side effects are of particular concern, the most common being Clostridium difficile-associated
diarrhea. Antibiotic stewardship is important when preventing and treating periprosthetic joint
infection to hopefully prevent increase of bacterial antibiotic resistance. Two recent studies showed a significant difference in the incidence of
surgical site infections after
arthroplasty procedures in high-risk patients during short- and long-term follow-up without significant increase of adverse effects. However, another study showed no significant benefit of this practice. This summary discussed the details of those studies suggesting that the use of extended oral
antibiotic prophylaxis in high-risk primary and revision hip and
knee arthroplasty may reduce
infection rates; nonetheless, additional higher level of evidence (level 1) is still needed to validate this practice as its potential adverse effects are not clear.