Debridement and implant retention (DAIR)

IV/PO antibiotic therapy for total of 3 months for elbows, shoulder, ankle, hip, and 6 months for knee prostheses.  OVIVA trial showed non-inferiority of early (within 7 days after surgery or start of antibiotic treatment) oral therapy compared with IV therapy with shorter duration of hospital stay and lower risk of IV complications [NEJM 2019;380:425-36].

One-stage exchange:

IV/PO antibiotic therapy for total of 3 months (all joints).  OVIVA trial showed non-inferiority of early (within 7 days after surgery or start of antibiotic treatment) oral therapy compared with IV therapy with shorter duration of hospital stay and lower risk of IV complications [NEJM 2019;380:425-36].

Two-stage exchange:

4-6 weeks IV/PO antibiotic therapy + ≥ 2 weeks antibiotic-free interval before re-implantation.  OVIVA trial showed non-inferiority of early (within 7 days after surgery or start of antibiotic treatment) oral therapy compared with IV therapy with shorter duration of hospital stay and lower risk of IV complications [NEJM 2019;380:425-36].

Postop: continue antimicrobial therapy until intraoperative cultures come back negative (as long as antibiotics were stopped ≥ 2 weeks prior to surgery) or for 6-12 weeks if positive intraoperative cultures. Tailor to C&S results.