利福平联合左氧氟沙星预防全髋关节置换后感染

背景：置换后合理使用抗生素是目前公认的预防全髋关节置换后关节假体周围感染的有效方法之一,但是具体使用哪一类抗生素、单用还是联用、最佳剂量和疗程等,国内外尚无统一意见.目的：探讨利福平联合左氧氟沙星预防全髋关节置换后感染的有效性和安全性.方法：将2011年1月至2012年6月施行初次全髋关节置换的患者随机分为试验组和对照组,每组150例,所有患者采用相同的置换方式.为预防感染,置换后住院期间内所有患者静脉应用头孢类抗生素.出院后试验组口服利福平（0.15 g,3次/d）和左氧氟沙星（0.1 g,3次/d）,疗程6周;对照组口服头孢类抗生素,疗程6周.统计随访期间内发生感染的例数并观察试验组药物不良反应发生情况.结果与结论：所有患者均获随访,随访时间24-36个月,试验组和对照组在末次随访时各有4例、13例患者发生了关节假体周围感染,两组感染率比较差异有显著性意义（P＜0.05）;试验组均未出现皮肤过敏、恶心呕吐、多关节疼痛等药物不良反应.提示初次全髋关节置换后长期口服利福平和左氧氟沙星可有效预防置换后关节（仉）体周围感染;联合使用此两种药物不增加药物不良反应发生的风险.该结论尚需大样本的随机对照研究加以验证.

Rifampicin combined with levofloxacin for preventing infection after total hip arthroplasty

BACKGROUND： Reasonable use of antibiotics postoperatively is widely recognized as one of the effective ways to prevent periprosthetic joint infection after total hip arthroplasty. However, at present there is no consensus in the best kind of antibiotics, sole or collective use, the best dosage and course of treatment.
OBJECTIVE： To explore the efficiency and safety of rifampicin combined levofloxacin for preventing periprosthetic joint infection after total hip arthroplasty.
METHODS： 300 patients, who accepted primary total hip arthroplasty between January 2011 and June 2012, were randomly divided into experimental group （n=150） and control group （n=150）. All patients accepted the same surgical procedure. Intravenous cephalosporins were used during hospitalization to prevent periprosthetic joint infection. After discharge, patients in experimental group were treated orally with rifampicin （0.15 g, three times/d） and levofloxacin （0.1 g, three times/d） for six weeks. Patients in the control group were orally given cephalosporins for six weeks. During the follow-up, the number of cases of periprosthetic joint infection was recorded and the adverse effects of drugs in experimental group were observed.
RESULTS AND CONCLUSION： All patients were followed-up for 24-36 months. Four patients in experimental group and thirteen patients in control group suffered from periprosthetic joint infection at the last followed-up, and the difference was significant between the two groups （P 〈 0.05）. No patients in the experimental group had the side-effects of drugs such as skin allergies, nausea and vomiting, or joint pain. These findings indicate that after total hip arthroplasty, oral treatment with rifampicin and levofloxacin can effectively prevent periprosthetic joint infection. Combination of the two drugs does not increase the risk of the side-effects of drugs. However, large-scale randomized controlled trials were needed to verify the conclusion.