Fluoroquinolones vs. tetracycline agents combined with rifampicin for periprosthetic joint infections: a comparative study

Objectives : Periprosthetic joint infections (PJIs) are predominantly caused by gram-positive bacteria. Fluoroquinolones (FQs), combined with rifampicin (RMP), are often used but may be unsuitable due to resistance, side effects, or intolerance. Second-generation tetracyclines (TTCs), such as doxycycline and minocycline, show promise as alternatives. This study compared the efficacy and tolerance of RMP–FQ versus RMP–TTC combinations in PJI treatment. Methods : A retrospective study at Tourcoing Hospital, France, reviewed staphylococcal- and streptococcal-related PJI cases treated with RMP–FQ or RMP–TTC from 2013 to 2021. Patients were followed up for 2 years. A Cox regression analysis was used to compare risk of failure. A propensity score using inverse probability of treatment weighting (IPTW) was performed to balance covariates. Results : Of 105 patients, 70 received RMP–FQ and 35 RMP–TTC. Infections were mainly monomicrobial (80 %). IPTW-adjusted Cox regression revealed no significant difference in treatment failure between the RMP–FQ and RMP–TTC groups (aHR 0.68; 95 % CI = 0.32–1.4). Subgroup analyses suggested no difference for infections caused by S. aureus (HR 1.1; CI 95 % = 0.3–4.0) or coagulase-negative staphylococci (CoNS) (HR 0.54; 95 % CI = 0.1–2.1). Adverse events were similar in both groups (20 % vs. 19 %, p >0.9). Conclusions : RMP–TTC therapy could be considered a potential therapeutic option for PJIs when FQs cannot be used.