Antibiotic Therapy as a Risk Factor for Chronic Residual and Phantom Limb Pain After Combat-Related Amputation: A 212-Patient Cohort Study

Abstract

Background:Antibiotic (AB) therapy is standard in managing combat-related infections, particularly after traumatic limb amputations. However, prolonged or combined antibiotic regimens may contribute to neuroinflammatory processes that predispose patients to chronic post-amputation pain (ChPAP), which combines the consepts of chronic residual limb pain (RLP) and phantom limb pain (PLP).

Objective To investigate associations between antibiotic use (duration, type, and combination) and the development of RLP and PLP in post-amputation military patients. Methods:This retrospective cohort study evaluated 212 military personnel treated between 2022 and 2024 for traumatic amputations. Antibiotic regimens, pain intensity, type, and chronicity were analyzed. Results: Chronic RLP/PLP developed in 94 patients (44.3%). Prolonged antibiotic use (>21 days) and combined regimens (≥2 antibiotics) were) were related with increased ChPAP risk in limbs Neuropathic pain was predominant in patients exposed to fluoroquinolones or metronidazole. Conclusion:Extended and multi-agent antibiotic therapy was associated with ChPAP after combat-related limb amputation. Personalized antimicrobial stewardship and early pain screening are recommended in this high-risk population.