Bone infections can be treated with six days of antibiotics instead of six weeks
An international trial of almost 500 patients, published in The New England Journal of Medicine, shows that placing antibiotics directly in infected bone during surgery cures as well as the usual six to twelve weeks of treatment, with far fewer side effects. Hospital del Mar in Barcelona was the only Spanish centre involved. Surgery is still needed: what changes is the antibiotic course afterwards.
Between 3% and 10% of joint replacement and fracture operations end up infected, according to Hospital del Mar in Barcelona. Until now, patients went back to theatre to remove the affected bone, spent about two weeks in hospital on intravenous antibiotics and then kept taking them at home for up to about three months. An international trial published in The New England Journal of Medicine shows another way: six days of antibiotics placed exactly where the infection is.
The trial, called SOLARIO, was led by Oxford University Hospitals, with 25 centres in the UK, Germany, Austria, Portugal and Spain. Hospital del Mar was the only Spanish centre to take part.
A bone substitute with the drug inside
During the same operation, surgeons fill the gap with a bone substitute that contains an antibiotic, so the drug goes straight to the infection. “With antibiotics placed where the infection is, we reach very high concentrations of the drug that cannot be achieved with conventional treatment without very serious side effects,” says Dr Daniel Pérez Prieto, head of orthopaedic surgery and traumatology at Hospital del Mar and one of the study’s authors.
Surgeons at Hospital del Mar during an operation. Photo: Hospital del Mar.
11% against 14%, and fewer side effects
Almost 500 patients operated on between 2019 and 2023 were randomly assigned to one of the two treatments and followed for a year. The infection was not cured in 11% of those given the local antibiotic, against 14% with the usual treatment: the new approach is no worse. Side effects fell from 45% to 17%.
According to the hospital, treatment lasted six days instead of 42, and the average hospital stay fell from fifteen to twelve days. It also saves about 6.4 kilos of antibiotics for every 100 patients, which matters in the fight against drug-resistant bacteria.
Dr Daniel Pérez Prieto of Hospital del Mar. Photo: Hospital del Mar.
What changes in hospital protocols
“Our data support changing the protocols for these patients, giving priority to bone substitutes with local antibiotics,” says Pérez Prieto. The next step is for hospitals to review their guidelines for this kind of infection.
