Fluoroquinolones are known to be accompanied by significant risks. However, the incidence of adverse events resulting in unplanned drug discontinuation when used for periprosthetic joint infections ( PJI ) is currently unknown.
The study included 156 patients over the age of 18 treated for staphylococcal periprosthetic joint infections 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 adverse events, unplanned Rifamycin discontinuation, mean time to unplanned regimen discontinuation, and all-cause mortality.
Overall, unplanned drug discontinuation occurred in 35.6% of patients in the fluoroquinolone group and 3% of patients in the non-fluoroquinolone group.
The rate of unplanned discontinuation of fluoroquinolone regimens as compared to non- fluoroquinolone regimens was 27.5% vs 4.2% ( p=0.021 ) in total hip arthroplasty infections and 42% vs 2.4% ( p less than 0.001 ) in total knee arthroplasty infections.
There was no significant difference in severe adverse effects between fluoroquinolone and non- fluoroquinolone regimens in both total hip arthroplasty and total knee arthroplasty infections.
The overall rate of non-severe adverse effects in fluoroquinolone compared to non-fluoroquinolone regimens was 43.3% versus 6.1% ( p less than 0.001 ).
Fluoroquinolones were associated with tendinopathy, myalgia, arthralgia, and nausea.
In conclusion, a significantly higher rate of unplanned drug discontinuation was associated with fluoroquinolone as compared to non-fluoroquinolone regimens.
This provides a real-world view of the implications of fluoroquinolone related adverse events on unplanned discontinuation when used in prolonged durations for the management of staphylococcal periprosthetic joint infections. ( Xagena )
Vollmer NJ et al, Clin Infect Dis 2021; Online ahead of print