Current therapeutic progression of Rifampicin in prosthetic joint infection

Prosthetic joint infection (PJI) is a devastating complication that can occur after any arthroplasty procedure and is associated with significant morbidity and substantial healthcare costs. Recently, the use of Rifampicin in PJI subjects has become a hot research direction in the field of orthopaedics, its efficacy is definite and encouraging. But till date, to the best of our knowledge, we still have no associated reports about the application of Rifampicin on PJI. Therefore, articles concerned with the administration of Rifampicin in PJI subjects published till date were retrieved from PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang and Weipu databases. The articles, which met the inclusion and exclusion criteria, were summarized into the following categories: 1) The development and the application status of Rifampicin on PJI; 2) The therapeutic mechanism of Rifampicin on PJI; 3) The usage of Rifampicin in the postoperative antimicrobial therapy. By reviewing the associated articles, we found out that PJI is difficult to treat, because the causative bacteria forms and exists in a biofilm that is adherent to the prosthetic surface. The formation and maturation of the bacterial biofilm is a time dependent process. The longer the biofilm exists, the troublesome it gets to eradicate. Rifampicin not only has an excellent anti-staphylococcal activity, but also has a very good oral bioavailability and good bone penetration. The application of Rifampicin may significantly improve the surgical success rate especially after debridement and retention in PJI subjects. However, the optimal course, dosage and route of administration still need further exploration.