Zimmerli rifampicin RCT

Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group.

Zimmerli W, Widmer AF, Blatter M, et al. JAMA 1998 · PMID 9605897 · doi:10.1001/jama.279.19.1537

Question

Does adding rifampicin to ciprofloxacin improve cure of staphylococcal infection associated with retained, stable orthopaedic implants?

Design

Small double-blind placebo-controlled RCT in Switzerland.

Patients

Patients with early staphylococcal infection of stable orthopaedic implants (fracture fixation devices and prostheses) after debridement with implant retention.

Intervention

Ciprofloxacin plus rifampicin

Comparison

Ciprofloxacin plus placebo

Primary outcome

Cure of infection with implant retained

Key result

Among patients completing the study, cure was significantly more frequent with the rifampicin combination than with ciprofloxacin alone.

Limitations

Very small sample with substantial drop-out; only staphylococcal infections with stable implants and short symptom duration.

Impact on practice

Foundation for rifampicin combination therapy (never as monotherapy) in staphylococcal biofilm infection treated with implant retention, including DAIR for PJI.