- Design
- Multicentre open-label non-inferiority randomised trial
- Population
- 500 adults after surgery for orthopaedic infection with a local-antibiotic carrier
- Primary outcome
- Definite treatment failure by 12 months
- Effect
- 11.1% (short) vs 14.1% (long); risk difference -3.0 points (95% CI -9.0 to 3.0)
Orthopaedic infection has long meant weeks of systemic antibiotics after surgery. SOLARIO, a multicentre open-label non-inferiority trial, tested whether that can be shortened when a local-antibiotic carrier is implanted at the operation.
Among 500 adults randomised after surgery for orthopaedic infection, definite treatment failure by 12 months occurred in 14.1% of those given a long systemic course of four weeks or more and 11.1% of those given a short course of seven days or less, a risk difference of -3.0 percentage points that met the non-inferiority margin. The short course was not just non-inferior: drug-related symptoms by six weeks were far lower, 17.2% against 45.2%.
The key condition is the implanted local-antibiotic carrier at surgery. Where that is part of the operation, a systemic course of a week or less is a reasonable, evidence-based choice that spares patients weeks of antibiotics and their harms.
- 500 adults randomised after surgery for orthopaedic infection with a local-antibiotic carrier implanted.
- Short systemic course was seven days or less; long course was four weeks or more.
- Treatment failure at 12 months was 11.1% (short) versus 14.1% (long), meeting non-inferiority.
- Drug-related symptoms by six weeks were far lower with the short course (17.2% vs 45.2%).
- The short course applies specifically when a local-antibiotic carrier is used at surgery.
Why it matters
It overturns the default of prolonged systemic antibiotics for orthopaedic infection in a defined surgical setting.
Don't overread it
The short course was tested only alongside an implanted local-antibiotic carrier and in an open-label trial; it does not license short systemic courses without local antibiotics.
The statistics, in plain English
A risk difference of -3.0 percentage points with a confidence interval of -9.0 to 3.0 stays within the pre-set 10-point non-inferiority margin, so the short course is not meaningfully worse. The large drop in drug-related symptoms (45.2% to 17.2%) is the clear patient-facing gain.
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