Complex orthopaedic infections: oral vs IV antibiotics?

  • Li HK & al.
  • N Engl J Med
  • 31 Jan 2019

  • curated by Sarfaroj Khan
  • UK Medical News
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Appropriately selected oral antibiotic therapy is noninferior to intravenous antibiotic therapy for complex orthopaedic infection, as assessed by treatment failure at 1 year, according to a new study published in The New England Journal of Medicine.

Researchers evaluated 1054 adults who were being treated for bone or joint infection at 26 UK centres. Participants were randomly assigned to receive antibiotics either intravenously (n=527) or orally (n=527) to complete the first 6 weeks of therapy starting within 7 days post-surgery or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment. Follow-on oral antibiotics were permitted in both groups. Definitive treatment failure within 1 year after randomisation was the main outcome.

Overall, 14.6% treatment failure occurred in the intravenous group and 13.2% in the oral group. The intention-to-treat analysis showed no difference in the risk for definitive treatment failure in both groups, indicating noninferiority (−1.4 percentage points; 90% CI, −4.9 to 2.2; 95% CI, −5.6 to 2.9). There were similar serious adverse events seen in both groups (intravenous, 27.7% vs oral, 26.2%; P=.58). Catheter complications were more common in the intravenous vs oral group (9.4% vs 1.0%). 

Authors commented, “Oral antibiotic therapy was associated with a shorter length of hospital stay and with fewer complications than intravenous therapy. However, oral therapy may not be appropriate for some patients in certain conditions such as poor enteral absorption and pathogens (e.g., resistance to oral agents).”

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