Oral antibiotics not inferior to IV-only therapy in blood, bone infections

Use of oral antibiotics in the treatment of osteomyelitis, bacteraemia, and infective endocarditis results in shorter hospital stay, has a better safety profile, and appears to be similarly effective when compared to intravenous (IV)-only therapy, a recent study has shown.

“Treatment guidelines should be modified to indicate that oral therapy is appropriate for reasonably selected patients with osteomyelitis, bacteraemia, and endocarditis,” the investigators said.

A systematic review was performed on prospective, controlled trials comparing IV-only to oral stepdown regimens in the treatment of these invasive bacterial infections.

The investigators used the PubMed database and identified seven relevant randomized controlled trials (RCTs) of osteomyelitis, nine of bacteraemia, one including both osteomyelitis and bacteraemia, and three of endocarditis, as well as one quasi-experimental endocarditis study.

Results were then synthesized through forest plots and funnel charts (for risk of study bias), with the use of RevMan 5.4.1 and Meta-Essentials freeware, respectively.

All 21 studies showed neither substantial difference in clinical efficacy nor superiority of IV-only vs oral antimicrobial therapy; no between-group difference was also seen for mortality.

In addition, none of the eligible studies demonstrated that IV-only treatment was better in terms of efficacy. However, patients in the IV-only group had greater frequency of catheter-related adverse events and duration of inpatient hospitalization.

“Numerous prospective, controlled investigations demonstrate that oral antibiotics are at least as effective, safer, and lead to shorter hospitalizations than IV-only therapy; no contrary data were identified,” the investigators said.