Clinical Scorecard: Comparing Single and Multiple Doses of Antibiotics for Prophylaxis in Total Hip Arthroplasty

At a Glance

Key Highlights

• PJI is uncommon but serious, associated with repeat surgery and higher mortality.

• International guidelines on antibiotic dosing for THA vary and are based on limited evidence.

• The study utilized Danish registry data to assess the effectiveness of single vs multiple antibiotic doses.

Guideline-Based Recommendations

Diagnosis

• The study identified PJI using microbiological criteria or a surgeon’s report of infection within 90 days after surgery.

Management

• Administer perioperative antibiotic prophylaxis for primary THA; the study compared a single preoperative dose with multiple doses, including postoperative doses.

• Study findings suggest a single preoperative dose may be noninferior to multiple doses for preventing PJI, although international dosing guidelines vary and evidence is limited.

Monitoring & Follow-up

• Assess for PJI during the first 90 days after surgery, the study’s follow-up period.

• Record infections meeting the study’s microbiological criteria or reported by the surgeon.

Risks

• PJI is uncommon but serious and may be associated with repeat surgery and higher mortality.

• Additional antibiotic exposure may contribute to antimicrobial resistance and adverse events; balance potential harms against the uncertain benefit of multiple doses.

Patient & Prescribing Data

Patients aged 18 and older undergoing primary THA for osteoarthritis.

Single preoperative antibiotic dose may be noninferior to multiple doses.

Clinical Best Practices

• Adhere to guidelines for antibiotic prophylaxis in THA.

• Utilize validated algorithms for accurate PJI diagnosis.

Related Resources & Content

Abedi AA, Anneberg M, Pedersen AB, Varnum C, Christensen R, Overgaard S. Single- vs multiple-dose antibiotic prophylaxis for total hip arthroplasty. JAMA Netw Open. 2026;9(9):e2634586. doi:10.1001/jamanetworkopen.2026.34586