There is little research on the impact of prolonged (>24-hour) antibiotic administration following primary and aseptic revision total joint arthroplasty (TJA) on periprosthetic joint infection rates (PJI). Therefore, for a study, researchers sought to comprehensively evaluate the consequences of prolonged prophylactic antibiotic treatment. In August 2021, a systematic search of the PubMed and EMBASE databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that satisfied the inclusion criteria were reviewed by two different writers. In addition, basic patient demographics, mode of delivery, antibiotic type, dosage, frequency, PJI rates, and duration of stay were obtained.

The final study included 11 papers published between 1979 and 2021. About 2 studies looked at aseptic revisions, seven looked at primary TJA, and two looked at both. Around 5 of the studies were randomized controlled trials, one was a multicenter, nonrandomized study, and the remaining five were retrospective cohort studies. All 11 trials utilized a cephalosporin or a penicillin antibiotic in both the control and cohort groups. Five studies utilized IV antibiotics, one research used PO antibiotics, and the remaining five studies used both IV and PO antibiotics. In 3 trials, all of which used IV antibiotics, reported on length of stay. All 11 studies looked at rates of PJI, whereas four looked at rates of superficial surgical site infections. When compared to a control group, four studies found a statistically significant decrease in PJI, while seven studies found no statistically significant change. There was contradictory information about the usefulness of IV or PO antibiotics for more than 24 hours following TJA. Therefore, current recommendations do not support the use of prolonged antibiotics; additional prospective clinical research will be required to better substantiate these statements.